title: Assessing patients with hepatocellular carcinoma meeting the Milan criteria: Is liver 3 tesla MR with gadoxetic acid necessary in addition to liver CT?
abstract: OBJECTIVE
  To determine the added value of 3 Tesla liver MR in patients with hepatocellular carcinoma (HCC) within the liver computed tomography (CT) -based Milan criteria.
  
  
  METHODS
  Liver CT and MR images of 130 patients with HCC within the Milan criteria based on liver CT were retrospectively reviewed. The number of MR-diagnosed HCCs and that of high risk hypervascular nodules (HRHNs), the effect of obtaining MR on patient management and CT appearances of MR-diagnosed HCCs and those of HRHNs were evaluated. Independent predictor for diagnosing additional HCCs on liver MR was analyzed.
  
  
  RESULTS
  A total of 18.5% (24/130) of patients had additional 39 HCCs on MR, with a 5.4% (7/130) dropout rate from the Milan criteria. 28.5% (37/130) of patients had additional 78 HRHNs. Overall, 39.2% (51/130) of patients required changes in management. The common CT appearances of MR-diagnosed HCCs were arterial enhancing lesions ≥ 0.5cm (38.4%, 15/39), low density nodules < 1.5 cm (30.8%, 12/39) and invisibility (28.2%, 11/39). For MR-diagnosed HRHNs, 55.1% (43/78) were invisible on CT. The presence of inconclusive lesions on CT was an independent predictor for diagnosing additional HCCs on MR.
  
  
  CONCLUSIONS
  For patients with HCCs within the Milan criteria on liver CT, liver MR may be necessary to detect additional HCCs and HRHNs.
authors.affiliation: Department of Radiology and Center for Imaging Science, Samsung Medical Center, Sungkyunkwan University School of Medicine, 50, Ilwon-Dong, Kangnam-Ku, Seoul, Republic of Korea.
authors.forename: Dong Ik
authors.initials: DI
authors.lastname: Cha
authors.forename: Min Woo
authors.initials: MW
authors.lastname: Lee
authors.forename: Young Kon
authors.initials: YK
authors.lastname: Kim
authors.forename: Seong Hyun
authors.initials: SH
authors.lastname: Kim
authors.forename: Hyun Jeong
authors.initials: HJ
authors.lastname: Park
authors.forename: Hyunchul
authors.initials: H
authors.lastname: Rhim
authors.forename: Hyo K
authors.initials: HK
authors.lastname: Lim
mesh_terms: D000328:Adult; D000368:Aged; D006528:Carcinoma, Hepatocellular / Q000175:diagnosis*; D003287:Contrast Media; D005060:Europe; D005260:Female; D019786:Gadolinium DTPA; D006801:Humans; D007089:Image Enhancement / Q000379:methods*; D008113:Liver Neoplasms / Q000175:diagnosis*; D008279:Magnetic Resonance Imaging / Q000379:methods / Q000592:standards*; D008297:Male; D008875:Middle Aged; D064847:Multimodal Imaging / Q000379:methods / Q000592:standards*; D009389:Neovascularization, Pathologic / Q000473:pathology; D015588:Observer Variation; D017410:Practice Guidelines as Topic; D015203:Reproducibility of Results; D012680:Sensitivity and Specificity; D014057:Tomography, X-Ray Computed / Q000379:methods / Q000592:standards*; D014481:United States
chemical_list: D003287:Contrast Media; C073590:gadolinium ethoxybenzyl DTPA; D019786:Gadolinium DTPA
keywords: carcinoma; hepatocellular; magnetic resonance imaging; neoplasm staging