title: Hepatocellular carcinoma lesion characterization: single-institution clinical performance review of multiphase gadolinium-enhanced MR imaging--comparison to prior same-center results after MR systems improvements.
abstract: OBJECTIVE
  To measure diagnostic performance in the detection of hepatocellular carcinoma (HCC) by using the most recent technology and multiphase gadolinium-enhanced magnetic resonance (MR) imaging and to compare with earlier results at the same institution.
  
  
  METHODS
  This retrospective study was institutional review board approved and HIPAA compliant. Informed consent was obtained. Between January 2008 and April 2010, 101 patients underwent liver transplantation and pretransplantation abdominal MR imaging within 90 days. Prospective image interpretations from the clinical record were reviewed for documentation of HCC, including size, number, and location. Liver explant histologic examination provided the reference standard for lesion analysis and was performed in axial gross slices in conjunction with the MR imaging report for direct comparison. Tumors were categorized according to size (≥ 2 cm or <2 cm), and MR imaging detection sensitivity, specificity, predictive values, and accuracy were calculated according to category. The Fisher exact test was used to compare results from this study against prior reported results.
  
  
  RESULTS
  Thirty-five (34.7%) of 101 patients had HCC at explant analysis. Patient-based analysis of all lesions showed a sensitivity and specificity of 97.1% (34 of 35) and 100% (66 of 66), respectively. For lesions 2 cm or larger, MR imaging had a sensitivity and specificity of 100% (23 of 23) and 100% (78 of 78), respectively. For lesions smaller than 2 cm, MR imaging had a sensitivity and specificity of 82.6% (19 of 23) and 100% (78 of 78), respectively. Lesion-based sensitivity for all tumors was 91.4% (53 of 58) in the current study, compared with 77.8% in 2007 (P = .07). For lesions smaller than 2 cm, the sensitivity was 87.5% (28 of 32) in the current study, compared with 55.6% previously (P = .02).
  
  
  CONCLUSIONS
  MR imaging remains a highly accurate diagnostic method for the preoperative evaluation of HCC, and detection of small (<2 cm) tumors has been significantly improved compared with that of earlier studies.
authors.affiliation: Department of Radiology, Emory University School of Medicine, Atlanta, Ga, USA.
authors.forename: David J S
authors.initials: DJ
authors.lastname: Becker-Weidman
authors.forename: Bobby
authors.initials: B
authors.lastname: Kalb
authors.forename: Puneet
authors.initials: P
authors.lastname: Sharma
authors.forename: Hiroumi D
authors.initials: HD
authors.lastname: Kitajima
authors.forename: Christina R
authors.initials: CR
authors.lastname: Lurie
authors.forename: Zhengjia
authors.initials: Z
authors.lastname: Chen
authors.forename: James R
authors.initials: JR
authors.lastname: Spivey
authors.forename: Stuart J
authors.initials: SJ
authors.lastname: Knechtle
authors.forename: Steven I
authors.initials: SI
authors.lastname: Hanish
authors.forename: N Volkan
authors.initials: NV
authors.lastname: Adsay
authors.forename: Alton B
authors.initials: AB
authors.lastname: Farris
authors.forename: Diego R
authors.initials: DR
authors.lastname: Martin
mesh_terms: D006528:Carcinoma, Hepatocellular / Q000175:diagnosis* / Q000473:pathology / Q000601:surgery; D003287:Contrast Media; D005260:Female; D006801:Humans; D008113:Liver Neoplasms / Q000175:diagnosis* / Q000473:pathology / Q000601:surgery; D016031:Liver Transplantation; D008279:Magnetic Resonance Imaging / Q000379:methods* / Q000592:standards; D008297:Male; D008536:Meglumine / Q000031:analogs & derivatives; D008875:Middle Aged; D009942:Organometallic Compounds; 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