title: Hypervascular hepatocellular carcinoma in the cirrhotic liver: diffusion-weighted imaging versus superparamagnetic iron oxide-enhanced MRI.
abstract: OBJECTIVE
  The purpose of the study was to validate diffusion-weighted imaging (DWI) in the assessment of hypervascular hepatocellular carcinoma (HCC) compared with superparamagnetic iron oxide (SPIO)-enhanced magnetic resonance imaging (MRI) in the cirrhotic liver.
  
  
  METHODS
  Forty-six consecutive patients with 106 hypervascular focal lesions in the cirrhotic liver who underwent DWI using three b factors and gadopentetate dimeglumine-enhanced dynamic MRI followed by SPIO-enhanced MRI were enrolled. Two independent radiologists evaluated two separated image sets (SPIO set, dynamic MRI and SPIO-enhanced T2*-weighted images; DWI set, DWI and dynamic MRI) and assigned confidence levels for diagnosis of HCC using a five-point scale for each lesion. Area under the receiver operating characteristic curve (A(z)) was calculated for each image set.
  
  
  RESULTS
  The A(z) value of the DWI set was larger than the SPIO set by both readers (reader 1, 0.936 vs. 0.900, P=.050; reader 2, 0.938 vs. 0.905, P=.110). For the sensitivity (reader 1, 93.1% vs. 86.2%, P=.146; reader 2, 95.4% vs. 88.5%, P=.070) and specificity (reader 1, 89.5% vs. 73.7%, P=.250; reader 2, 79.0% vs. 73.7%, P=1.000) of HCC diagnosis, DWI sets were superior to SPIO sets without statistically significant differences.
  
  
  CONCLUSIONS
  For assessment of hypervascular HCC, DWI in combination with dynamic MRI provides comparable or slightly better information compared with the combination of dynamic and SPIO-enhanced MRI.
authors: Department of Radiology and the Research Institute of Radiological Science, Yonsei University College of Medicine, Gangnam Severance Hospital, Gangnam-Gu, Seoul 135-720, Republic of Korea.
authors: Jin
authors: J
authors: Chung
authors: Jeong-Sik
authors: JS
authors: Yu
authors: Dae Jung
authors: DJ
authors: Kim
authors: Jae-Joon
authors: JJ
authors: Chung
authors: Joo Hee
authors: JH
authors: Kim
authors: Ki Whang
authors: KW
authors: Kim
mesh_terms: D006528:Carcinoma, Hepatocellular / Q000473:pathology*; D003287:Contrast Media / Q000494:pharmacology; D038524:Diffusion Magnetic Resonance Imaging / Q000379:methods; D005290:Ferric Compounds / Q000494:pharmacology*; D005355:Fibrosis / Q000821:virology; D019786:Gadolinium DTPA / Q000494:pharmacology; D006801:Humans; D008099:Liver / Q000473:pathology; D008103:Liver Cirrhosis / Q000473:pathology*; D008113:Liver Neoplasms / Q000473:pathology*; D008279:Magnetic Resonance Imaging / Q000379:methods*; D015588:Observer Variation; D012372:ROC Curve; D011871:Radiology / Q000379:methods; D012680:Sensitivity and Specificity
chemical_list: D003287:Contrast Media; D005290:Ferric Compounds; C073590:gadolinium ethoxybenzyl DTPA; C000499:ferric oxide; D019786:Gadolinium DTPA