title: Which is the best MRI marker of malignancy for atypical cirrhotic nodules: hypointensity in hepatobiliary phase alone or combined with other features? Classification after Gd-EOB-DTPA administration.
abstract: OBJECTIVE
  To investigate whether the malignancy of atypical nodules in cirrhosis can be identified at gadoxetic-acid-disodium(Gd-EOB-DTPA)-MRI by their hypointensity in the hepatobiliary(HB)-phase alone or combined with any other MR imaging features.
  
  
  METHODS
  One hundred eleven atypical nodules detected in 77 consecutive Gd-EOB-DTPA-MRIs were divided, based on arterial-phase behavior, into: Class I, isovascular (n = 82), and Class II, hypervascular without portal/delayed washout (n = 29). The two classes were further grouped based on HB-phase intensity (A/B/C hypo/iso/hyperintensity). Portal/venous/equilibrium-phase behavior and T2w features were also collected. Histology was the gold standard. Per-nodule sensitivity, specificity, negative and positive predictive values (NPV/PPV), and diagnostic accuracy were calculated for HB-phase hypointensity alone, and combined with vascular patterns and T2w hyperintensity.
  
  
  RESULTS
  Histology detected 60 benign and 51 malignant/premalignant nodules [10 overt hepatocellular carcinomas (HCCs) and 41 high-grade dysplastic nodules (HGDN)/early HCC]. Class IA contained 31 (94%) malignancies, IB one (3%), and IC only benign lesions. Class IIA had 100% malignancies, IIB three (37.5%) and IIC only two (28.5%). HB-phase hypointensity alone (Classes I-IIA) had 88% sensitivity, 91% NPV, and 93% diagnostic accuracy, superior (P < 0.05, P < 0.006, and P < 0.05, respectively) to any other MR imaging feature alone or combined.
  
  
  CONCLUSIONS
  In atypical cirrhotic nodules, HB-phase hypointensity by itself is the strongest marker of malignancy.
authors.affiliation: Radiology Unit, Department of Digestive Diseases and Internal Medicine; Sant'Orsola-Malpighi Hospital, University of Bologna, Via Albertoni 15, Bologna, Italy.
authors.forename: Rita
authors.initials: R
authors.lastname: Golfieri
authors.forename: Luigi
authors.initials: L
authors.lastname: Grazioli
authors.forename: Emanuela
authors.initials: E
authors.lastname: Orlando
authors.forename: Ada
authors.initials: A
authors.lastname: Dormi
authors.forename: Vincenzo
authors.initials: V
authors.lastname: Lucidi
authors.forename: Beniamino
authors.initials: B
authors.lastname: Corcioni
authors.forename: Ernesto
authors.initials: E
authors.lastname: Dettori
authors.forename: Laura
authors.initials: L
authors.lastname: Romanini
authors.forename: Matteo
authors.initials: M
authors.lastname: Renzulli
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000465:Algorithms; D015415:Biomarkers; D003287:Contrast Media / Q000008:administration & dosage; D005260:Female; D019786:Gadolinium DTPA / Q000008:administration & dosage; D006801:Humans; D007089:Image Enhancement / Q000379:methods*; D007090:Image Interpretation, Computer-Assisted / Q000379:methods*; D008103:Liver Cirrhosis / Q000150:complications / Q000473:pathology*; D008113:Liver Neoplasms / Q000209:etiology / Q000473:pathology*; D008279:Magnetic Resonance Imaging / Q000379:methods*; D008297:Male; D008875:Middle Aged; D015203:Reproducibility of Results; D012680:Sensitivity and Specificity
chemical_list: D015415:Biomarkers; D003287:Contrast Media; C073590:gadolinium ethoxybenzyl DTPA; D019786:Gadolinium DTPA