title: Hepatocellular carcinoma in a North American population: does hepatobiliary MR imaging with Gd-EOB-DTPA improve sensitivity and confidence for diagnosis?
abstract: OBJECTIVE
  To evaluate the value of hepatobiliary phase imaging for detection and characterization of hepatocellular carcinoma (HCC) in liver MRI with Gd-EOB-DTPA, in a North American population.
  
  
  METHODS
  One hundred MRI examinations performed with the intravenous injection of Gd-EOB-DTPA in patients with cirrhosis were reviewed retrospectively. Nodules were classified as HCC (n = 70), indeterminate (n = 33), or benign (n = 22). Five readers independently reviewed each examination with and without hepatobiliary phase images (HBP). Lesion conspicuity scores were compared between the two readings. Lesion detection, confidence scores, and receiver operating characteristic (ROC) analysis were compared.
  
  
  RESULTS
  Lesion detection was slightly improved for all lesion types with the inclusion of the HBP, and was substantially higher for small HCCs (96.0% versus 85.3%). Mean confidence scores for the diagnosis of HCC increased for HCCs overall and each size category (P < 0.001). Diagnostic performance improved with the addition of the HBP (aggregate AROC 87.7% versus 80.0%, P < 0.01), and sensitivity for characterization improved (90.9% versus 78.3%, P < 0.01) while specificity was unchanged.
  
  
  CONCLUSIONS
  Hepatobiliary phase imaging may improve small lesion detection (<1 cm) and characterization of lesions in general, in MRI of the cirrhotic liver with Gd-EOB-DTPA.
authors.affiliation: Department of Radiology, Duke University Medical Center, Durham, North Carolina 27710, USA. mustafa.bashir@duke.edu
authors.forename: Mustafa R
authors.initials: MR
authors.lastname: Bashir
authors.forename: Rajan T
authors.initials: RT
authors.lastname: Gupta
authors.forename: Matthew S
authors.initials: MS
authors.lastname: Davenport
authors.forename: Brian C
authors.initials: BC
authors.lastname: Allen
authors.forename: Tracy A
authors.initials: TA
authors.lastname: Jaffe
authors.forename: Lisa M
authors.initials: LM
authors.lastname: Ho
authors.forename: Daniel T
authors.initials: DT
authors.lastname: Boll
authors.forename: Elmar M
authors.initials: EM
authors.lastname: Merkle
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D006528:Carcinoma, Hepatocellular / Q000175:diagnosis* / Q000453:epidemiology*; D015897:Comorbidity; D003287:Contrast Media; D005260:Female; D019786:Gadolinium DTPA; D006801:Humans; D008103:Liver Cirrhosis / Q000175:diagnosis* / Q000453:epidemiology*; D008279:Magnetic Resonance Imaging / Q000706:statistics & numerical data*; D008297:Male; D008875:Middle Aged; D009657:North Carolina / Q000453:epidemiology; D015995:Prevalence; D015203:Reproducibility of Results; D012307:Risk Factors; D012680:Sensitivity and Specificity
chemical_list: D003287:Contrast Media; C073590:gadolinium ethoxybenzyl DTPA; D019786:Gadolinium DTPA