title: Can the patient with cirrhosis be imaged for hepatocellular carcinoma without gadolinium?: Comparison of combined T2-weighted, T2*-weighted, and diffusion-weighted MRI with gadolinium-enhanced MRI using liver explantation standard.
abstract: OBJECTIVE
  This study aimed to evaluate a non-gadolinium-enhanced magnetic resonance imaging (MRI) protocol including T2-weighted, T2*-weighted, and diffusion-weighted MRI sequences for identifying hepatocellular carcinoma (HCC) with liver explantation as the reference standard. Also, a stand-alone pre- and dynamic post-gadolinium-enhanced liver MRI data set was interpreted from the available patient data for relative comparison purposes.
  
  
  METHODS
  A retrospective review identified 37 appropriately selected liver transplant patients who had had preoperative MRI. Two data sets were created from the MRI studies: (1) non-gadolinium-enhanced (including T2-weighted, T2*-weighted, and diffusion-weighted sequences) and (2) pre- and dynamic post-gadolinium-enhanced (3-dimensional T1-weighted gradient recalled echo) and were presented to 2 independent, blinded observers. A separate blinded observer assessed the pathologic results from liver explantation to establish the reference standard.
  
  
  RESULTS
  On explant pathology, 21 of 37 patients had 31 HCC (mean [SD] largest diameter, 19 [9] cm; range, 7-40 mm). Per-lesion sensitivity of non-gadolinium-enhanced MRI for identifying HCC was 52% (reader 1) and 55% (reader 2), and specificity was 90% (reader 1) and 88% (reader 2). Per-lesion sensitivity of the stand-alone pre- and dynamic post-gadolinium-enhanced MRI was 84% (reader 1) and 81% (reader 2), and specificity was 62% (reader 1) and 65% (reader 2).
  
  
  CONCLUSIONS
  Non-gadolinium-enhanced MRI had a moderate sensitivity for HCC but had a high specificity. Although non-gadolinium-enhanced MRI cannot be recommended as a primary imaging approach for HCC, the results demonstrate the contribution of non-gadolinium-enhanced sequences to imaging of HCC. A non-gadolinium-enhanced MRI protocol may have a diagnostic value when gadolinium cannot be administered.
authors.affiliation: Department of Radiology and Radiological Science, Medical University of South Carolina, Charleston, SC, USA. andrewdhardie@gmail.com
authors.forename: Andrew D
authors.initials: AD
authors.lastname: Hardie
authors.forename: Michael K
authors.initials: MK
authors.lastname: Kizziah
authors.forename: Michael S
authors.initials: MS
authors.lastname: Rissing
mesh_terms: D000328:Adult; D000368:Aged; D006528:Carcinoma, Hepatocellular / Q000175:diagnosis*; D003287:Contrast Media; D038524:Diffusion Magnetic Resonance Imaging; D005260:Female; D019786:Gadolinium DTPA; D006801:Humans; D008103:Liver Cirrhosis / Q000150:complications*; D008113:Liver Neoplasms / Q000175:diagnosis*; D016031:Liver Transplantation; D016015:Logistic Models; D008279:Magnetic Resonance Imaging / Q000379:methods*; D008297:Male; D008875:Middle Aged; D012016:Reference Values; D012189:Retrospective Studies; D012680:Sensitivity and Specificity; D018709:Statistics, Nonparametric
chemical_list: D003287:Contrast Media; D019786:Gadolinium DTPA