title: Evidence of diagnostic enhancement pattern in hepatocellular carcinoma nodules ≤2 cm according to the AASLD/EASL revised criteria.
abstract: OBJECTIVE
  To define the percentage of small (≤2 cm) hepatocellular carcinoma (HCC) nodules showing the diagnostic enhancement pattern at CEUS, computed tomography (CT), and gadobenate dimeglumine (Gd-BOPTA)-enhanced magnetic resonance (MR) imaging.
  
  
  METHODS
  42 cirrhotic patients (26 male, 16 female; 67 ± 12 years) with 46 biopsy-proven HCCs ≤2 cm were included. Each HCC was scanned by CEUS, contrast-enhanced CT, and Gd-BOPTA-enhanced MR imaging. Nodule enhancement was evaluated by two readers. Independent analysis was followed by consensual analysis and the proportion of HCCs with the diagnostic enhancement pattern (nodule hyperenhancing on hepatic arterial phase and hypoenhancing on portal venous-late phase) on CEUS, CT, and MR imaging was compared by chi-square test.
  
  
  RESULTS
  Very good inter-reader agreement was observed on hepatic arterial phase and portal venous-late phase: CEUS, k = 0.89 and 0.85; CT, k = 0.91 and 0.88; MR imaging, k = 0.96 and 0.94. CEUS and CT did not differ in the percentage of HCC nodules with a diagnostic enhancement pattern (18/46 and 16/46; P = 0.66), while MR imaging revealed the diagnostic pattern in higher percentage of nodules (29/46; P = 0.012) in comparison to CEUS and CT.
  
  
  CONCLUSIONS
  CEUS and contrast-enhanced CT did not differ in the percentage of small HCC nodules with diagnostic enhancement pattern, while Gd-BOPTA-enhanced MR imaging revealed the diagnostic pattern in a higher nodule number in comparison to CEUS and CT.
authors.affiliation: Department of Radiology, Cattinara Hospital, University of Trieste, Strada di Fiume 447, 34149, Trieste, Italy, quaia@units.it.
authors.forename: Emilio
authors.initials: E
authors.lastname: Quaia
authors.forename: Luca
authors.initials: L
authors.lastname: De Paoli
authors.forename: Roberta
authors.initials: R
authors.lastname: Angileri
authors.forename: Riccardo
authors.initials: R
authors.lastname: Pizzolato
authors.forename: Biagio
authors.initials: B
authors.lastname: Cabibbo
authors.forename: Maria Assunta
authors.initials: MA
authors.lastname: Cova
mesh_terms: D000368:Aged; D001706:Biopsy; D006528:Carcinoma, Hepatocellular / Q000175:diagnosis* / Q000000981:diagnostic imaging / Q000473:pathology; D003287:Contrast Media; D003937:Diagnosis, Differential; D005260:Female; D006801:Humans; D007090:Image Interpretation, Computer-Assisted; D007472:Iohexol / Q000031:analogs & derivatives; D007479:Iopamidol / Q000031:analogs & derivatives; D008103:Liver Cirrhosis / Q000150:complications; D008113:Liver Neoplasms / Q000175:diagnosis* / Q000000981:diagnostic imaging / Q000473:pathology; D008279:Magnetic Resonance Imaging / Q000379:methods*; D008297:Male; D008536:Meglumine / Q000031:analogs & derivatives; D008875:Middle Aged; D009942:Organometallic Compounds; D010743:Phospholipids; D015203:Reproducibility of Results; D012189:Retrospective Studies; D013382:Subtraction Technique; D013459:Sulfur Hexafluoride; D014057:Tomography, X-Ray Computed / Q000379:methods*; D014463:Ultrasonography
chemical_list: D003287:Contrast Media; D009942:Organometallic Compounds; D010743:Phospholipids; C420843:contrast agent BR1; C064572:gadobenic acid; C057937:iomeprol; D007472:Iohexol; D008536:Meglumine; C038192:iopromide; D007479:Iopamidol; D013459:Sulfur Hexafluoride