title: Diagnosis of focal liver lesions with gadoxetic acid-enhanced MRI: is a shortened delay time possible by adding diffusion-weighted imaging?
abstract: OBJECTIVE
  To determine whether the diagnostic performance of combined gadoxetic acid-enhanced dynamic phases and diffusion-weighted imaging (DWI) is comparable to the standard protocol with hepatobiliary phase (HBP) and DWI for detection and characterization of focal liver lesions in chronic liver disease.
  
  
  METHODS
  A total of 176 patients with 181 HCCs, 15 cholangiocarcinomas, and 32 benign lesions were included. Three combined gadoxetic acid-enhanced and DWI sets (dynamic phases [arterial, portal, and 3-min delay {3-min set} and dynamic phases with 10-min HBP [10-min set] or 20-min HBP [20-min set]) were analyzed by two observers to determine the diagnostic accuracy and sensitivity in detection of malignancy, and ability for lesion characterization.
  
  
  RESULTS
  There was a trend, although not statistically significant, toward highest diagnostic accuracy and sensitivity for detecting malignancies in the 20-min set (mean, 0.945, 96.2), followed by the 10-min set (0.937, 95.9), and the 3-min set (0.923, 94.1) (P > 0.05). For lesion characterization, three image sets were equivalent (P > 0.05).
  
  
  CONCLUSIONS
  For lesion detection and characterization in chronic liver diseases, 3-min set with DWI showed comparable efficacy to 10-min or 20-min set. However, the best diagnostic performance could be achieved by combination of all image sets.
authors.affiliation: Department of Radiology and Center for Imaging Science, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea.
authors.forename: Moon Young
authors.initials: MY
authors.lastname: Kim
authors.forename: Young Kon
authors.initials: YK
authors.lastname: Kim
authors.forename: Hyun Jeong
authors.initials: HJ
authors.lastname: Park
authors.forename: Min Jung
authors.initials: MJ
authors.lastname: Park
authors.forename: Won Jae
authors.initials: WJ
authors.lastname: Lee
authors.forename: Dongil
authors.initials: D
authors.lastname: Choi
mesh_terms: D000368:Aged; D006528:Carcinoma, Hepatocellular / Q000175:diagnosis* / Q000473:pathology; D003287:Contrast Media / Q000737:chemistry; D038524:Diffusion Magnetic Resonance Imaging; D058625:End Stage Liver Disease / Q000473:pathology; D005260:Female; D019786:Gadolinium DTPA / Q000737:chemistry*; D006801:Humans; D007091:Image Processing, Computer-Assisted; D008113:Liver Neoplasms / Q000175:diagnosis* / Q000473:pathology; D008297:Male; D008875:Middle Aged; D015588:Observer Variation; D012015:Reference Standards; D015203:Reproducibility of Results; D012189:Retrospective Studies; D012680:Sensitivity and Specificity; D013997:Time Factors
chemical_list: D003287:Contrast Media; C073590:gadolinium ethoxybenzyl DTPA; D019786:Gadolinium DTPA
keywords: Gd-EOB-DTPA; chronic liver disease; diffusion-weighted imaging; hepatobiliary phase; hepatocellualr carcinoma; liver MRI