title: Detection of small (≤2 cm) HCC in cirrhotic patients: added value of diffusion MR-imaging.
abstract: OBJECTIVE
  To evaluate the usefulness of the diffusion-weighted sequence in the detection of small (≤2 cm) hepatocellular carcinoma (HCC) in patients with cirrhosis.
  
  
  METHODS
  Seventy cirrhotic patients with 93 HCCs underwent MR-Imaging at 1.5 T. MR acquisitions comprised unenhanced T1- and T2-weighted images and post-contrast Gd-BOPTA-enhanced T1W GRE-3D images acquired after approximately 25, 60, 180 s (dynamic phases) and 90 min (hepatobiliary phase). DWI was performed by a SSEPI sequence (b values 0, 50, 400, 800 s/mm(2)). Quantitative analysis was performed to establish significant difference of ADC values of benign lesions compared with that of HCC. Sensitivity, specificity, positive and negative predictive values and diagnostic accuracy of two different protocols with and without diffusion MRI sequence were also calculated and compared each other.
  
  
  RESULTS
  A good inverse correlation was found between reference standard and ADC values (ρ = -0.688). The mean ADC value of HCC was significantly lower than the mean value of benign focal liver lesions (p < 0.0001). No significant difference was reported in term of sensitivity, specificity, PPV, NPV and diagnostic accuracy between the two datasets. A trend to a better sensitivity was found when DWI images were considered.
  
  
  CONCLUSIONS
  The adjunction of DWI does not significantly improve the diagnostic accuracy in the detection of small HCC.
authors.affiliation: Department of Radiological Sciences, Oncology and Anatomical Pathology "Sapienza", Università di Roma, Viale Regina Elena 324, 00161, Rome, Italy, micdimartino@hotmail.it.
authors.forename: Michele
authors.initials: M
authors.lastname: Di Martino
authors.forename: Rossella
authors.initials: R
authors.lastname: Di Miscio
authors.forename: Gianmaria
authors.initials: G
authors.lastname: De Filippis
authors.forename: Concetta Valentina
authors.initials: CV
authors.lastname: Lombardo
authors.forename: Luca
authors.initials: L
authors.lastname: Saba
authors.forename: Daniel
authors.initials: D
authors.lastname: Geiger
authors.forename: Carlo
authors.initials: C
authors.lastname: Catalano
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D006528:Carcinoma, Hepatocellular / Q000175:diagnosis*; D003287:Contrast Media; D038524:Diffusion Magnetic Resonance Imaging / Q000379:methods*; D005260:Female; D006801:Humans; D007091:Image Processing, Computer-Assisted; D021621:Imaging, Three-Dimensional; D008103:Liver Cirrhosis / Q000150:complications*; D008113:Liver Neoplasms / Q000175:diagnosis*; D008297:Male; D008536:Meglumine / Q000031:analogs & derivatives; D008875:Middle Aged; D009942:Organometallic Compounds; D011237:Predictive Value of Tests; D012680:Sensitivity and Specificity
chemical_list: D003287:Contrast Media; D009942:Organometallic Compounds; C064572:gadobenic acid; D008536:Meglumine