title: Analysis of gadobenate dimeglumine-enhanced MR findings for characterizing small (1-2-cm) hepatic nodules in patients at high risk for hepatocellular carcinoma.
abstract: OBJECTIVE
  To retrospectively identify magnetic resonance (MR) imaging findings that are associated with hepatocellular carcinoma (HCC) in 1-2-cm nodules detected at surveillance ultrasonography (US) and to propose newer MR imaging diagnostic criteria.
  
  
  METHODS
  Institutional research ethics board approval was obtained, and informed patient consent was waived. Among 145 consecutive patients who had 1-2-cm nodules that were newly detected at surveillance US, 108 patients underwent gadobenate dimeglumine-enhanced MR imaging. After excluding hemangiomas and unconfirmed nodules, the study sample comprised 96 patients with 116 nodules, including 43 HCCs and 73 benign nodules. MR imaging findings were assessed for signal intensity at each sequence. On the basis of the results of univariate and multivariable logistic regression analyses, several diagnostic criteria were developed by using combinations of MR imaging findings, which were then compared with the American Association for the Study of Liver Diseases (AASLD) practice guideline.
  
  
  RESULTS
  Univariate analysis revealed four imaging findings associated with HCC, including arterial phase hyperintensity, portal or delayed phase hypointensity (washout), hyperintensity on T2-weighted images, and hepatobiliary phase hypointensity (P < .001 for each). In the multivariable analysis, arterial phase hyperintensity (adjusted odds ratio [OR], 17.1; P = .003) and washout (adjusted OR, 11.7; P = .007) were associated with HCC. Of the developed criteria, the criteria including nodules fitting the AASLD practice guideline (arterial phase hyperintensity and washout) or nodules having three or more findings were considered most reasonable, showing improved sensitivity (77% [33 of 43] versus 67% [29 of 43], P = .048) and comparable specificity (95% [69 of 73] versus 99% [72 of 73], P = .09), as compared with AASLD practice guideline.
  
  
  CONCLUSIONS
  Alternative MR imaging criteria for diagnosing HCC in 1-2-cm nodules detected at surveillance US that can improve sensitivity compared with the AASLD practice guideline were proposed. A larger study is needed to verify the preliminary criteria in this study.
  
  
  BACKGROUND
  http://radiology.rsna.org/lookup/suppl/doi:10.1148/radiol.11101549/-/DC1.
authors.affiliation: Department of Medical Imaging, University of Toronto, Toronto General Hospital, 585 University Ave, Toronto, ON, Canada M5G 2N2. taekyoung.kim@uhn.on.ca
authors.forename: Tae Kyoung
authors.initials: TK
authors.lastname: Kim
authors.forename: Kyoung Ho
authors.initials: KH
authors.lastname: Lee
authors.forename: Hyun-Jung
authors.initials: HJ
authors.lastname: Jang
authors.forename: Masoom A
authors.initials: MA
authors.lastname: Haider
authors.forename: Lindsay M
authors.initials: LM
authors.lastname: Jacks
authors.forename: Ravi J
authors.initials: RJ
authors.lastname: Menezes
authors.forename: Seong Ho
authors.initials: SH
authors.lastname: Park
authors.forename: Leyla
authors.initials: L
authors.lastname: Yazdi
authors.forename: Morris
authors.initials: M
authors.lastname: Sherman
authors.forename: Korosh
authors.initials: K
authors.lastname: Khalili
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D006528:Carcinoma, Hepatocellular / Q000175:diagnosis* / Q000473:pathology; D003287:Contrast Media; D005260:Female; D006801:Humans; D008113:Liver Neoplasms / Q000175:diagnosis* / Q000473:pathology; D016015:Logistic Models; D008279:Magnetic Resonance Imaging / Q000379:methods*; D008297:Male; D008536:Meglumine / Q000031:analogs & derivatives*; D008875:Middle Aged; D009942:Organometallic Compounds; D011159:Population Surveillance; D017410:Practice Guidelines as Topic; D011237:Predictive Value of Tests; D012189:Retrospective Studies; D012680:Sensitivity and Specificity
chemical_list: D003287:Contrast Media; D009942:Organometallic Compounds; C064572:gadobenic acid; D008536:Meglumine