title: 3 T MRI of hepatocellular carcinomas in patients with cirrhosis: does T2-weighted imaging provide added value?
abstract: OBJECTIVE
  To assess whether T2-weighted imaging (T2WI) provides any added value for the detection of hepatocellular carcinoma (HCC) in patients with cirrhosis, especially for lesions smaller than 2 cm.
  
  
  METHODS
  Sixty-five patients with cirrhosis underwent liver 3 T MRI. Images were qualitatively analysed independently by two observers in two separate sessions, including a dynamic enhanced session and a combination of dynamic and T2WI. The diagnostic accuracy was evaluated using the alternating free-response receiver operating characteristic. Sensitivity and positive predictive values were calculated for all HCCs and for the subgroup of HCCs that were smaller than 2 cm. Additionally, artefacts on T2WI were evaluated by two observers in consensus.
  
  
  RESULTS
  Ninety HCCs (>2 cm n = 36; ≤2 cm n = 54) were detected in 46 patients. For all HCCs and for lesions smaller than 2 cm, the sensitivities were significantly higher for the combined session than the dynamic session alone (p < 0.05). Conversely, for the Az and positive predictive values, there was no significant difference between the two sessions. For smaller HCC, 9% (5/54) and 7% (4/54) of the 54 HCCs were correctly interpreted by observers 1 and 2, respectively, only when T2WI was included. Three false-positive lesions (≤2 cm) were correctly diagnosed by one of the observers after combining T2WI. Conspicuity of only one large HCC was severely reduced by the artefacts from massive ascites.
  
  
  CONCLUSIONS
  At 3 T liver imaging, combining with T2WI can improve the sensitivity of detection of HCC compared with dynamic MRI alone by increasing observer confidence, especially for lesions smaller than 2 cm. Additionally, T2 image quality was not significantly affected by artefacts.
authors.affiliation: Shandong Medical Imaging Research Institute, Shandong University, Jinan, PR China.
authors.forename: L
authors.initials: L
authors.lastname: Guo
authors.forename: C
authors.initials: C
authors.lastname: Liang
authors.forename: T
authors.initials: T
authors.lastname: Yu
authors.forename: G
authors.initials: G
authors.lastname: Wang
authors.forename: N
authors.initials: N
authors.lastname: Li
authors.forename: H
authors.initials: H
authors.lastname: Sun
authors.forename: F
authors.initials: F
authors.lastname: Gao
authors.forename: C
authors.initials: C
authors.lastname: Liu
mesh_terms: D000328:Adult; D000368:Aged; D016477:Artifacts; D006528:Carcinoma, Hepatocellular / Q000175:diagnosis*; D005188:False Negative Reactions; D005189:False Positive Reactions; D005260:Female; D006801:Humans; D008103:Liver Cirrhosis / Q000150:complications*; D008113:Liver Neoplasms / Q000175:diagnosis*; D008279:Magnetic Resonance Imaging / Q000379:methods*; D008297:Male; D008875:Middle Aged; D015588:Observer Variation; D012680:Sensitivity and Specificity