title: Susceptibility-weighted imaging for the noncontrast evaluation of hepatocellular carcinoma: a prospective study with histopathologic correlation.
abstract: BACKGROUND
  Specific morphologic features of hepatocellular carcinoma (HCC) on imaging have identifiable pathologic correlates as well as implications for altering surgical management and defining prognosis. In this study, we compared susceptibility-weighted imaging (SWI) to conventional techniques and correlated our findings with histopathology to determine the role of SWI in assessing morphologic features of HCC without using a contrast agent.
  
  
  METHODS
  86 consecutive patients with suspected HCC were imaged with MRI (including T1, T2, T2*, and SWI) and subsequently CT. 59 histologically-proven HCC lesions were identified in 53 patients. Each lesion on each imaging sequence was evaluated by two radiologists, and classified with respect to lesion morphology, signal intensity relative to surrounding hepatic parenchyma, presence of a pseudocapsule, presence of venous invasion, and internal homogeneity.
  
  
  RESULTS
  Histopathology confirmed pseudocapsules in 41/59 lesions. SWI was able to detect a pseudocapsule in 34/41 lesions; compared to conventional T1/T2 imaging (12/41) and T2* (27/41). Mosaic pattern was identified in 25/59 lesions by histopathology; SWI confirmed this in all 25 lesions, compared to T1/T2 imaging (13/25) or T2* (18/25). Hemorrhage was confirmed by histopathology in 43/59 lesions, and visible on SWI in 41/43 lesions, compared to T1/T2 (7/43) and T2* (38/43). Venous invasion was confirmed by histopathology in 31/59 patients; SWI demonstrated invasion in 28/31 patients, compared to T1/T2 (7/31) and T2* (24/31).
  
  
  CONCLUSIONS
  SWI is better at identifying certain morphologic features such as pseudocapsule and hemorrhage than conventional MRI without using a contrast agent in HCC patients.
authors.affiliation: Department of Radiology, Southwest Hospital, Third Military Medical University, Chongqing, China.
authors.forename: Wei
authors.initials: W
authors.lastname: Chen
authors.affiliation: Department of Radiology, Henry Ford Hospital, Detroit, Michigan, United States of America.
authors.forename: Zachary
authors.initials: Z
authors.lastname: DelProposto
authors.affiliation: Department of Hepatobiliary Surgery, Southwest Hospital, Third Military Medical University, Chongqing, China.
authors.forename: Wei
authors.initials: W
authors.lastname: Liu
authors.affiliation: Department of Radiology, Wayne State University, Detroit, Michigan, United States of America.
authors.forename: Mohammad
authors.initials: M
authors.lastname: Kassir
authors.affiliation: Cancer Biotherapy Center, Hunan Provincial Tumor Hospital, Xiangya Medical School, Central South University, Hunan, China.
authors.forename: Zhiyuan
authors.initials: Z
authors.lastname: Wang
authors.affiliation: Department of Radiology, Southwest Hospital, Third Military Medical University, Chongqing, China.
authors.forename: Jun
authors.initials: J
authors.lastname: Zhao
authors.affiliation: Department of Radiology, Southwest Hospital, Third Military Medical University, Chongqing, China.
authors.forename: Bing
authors.initials: B
authors.lastname: Xie
authors.affiliation: Department of Radiology, Southwest Hospital, Third Military Medical University, Chongqing, China.
authors.forename: Yaming
authors.initials: Y
authors.lastname: Wen
authors.affiliation: Department of Radiology, Southwest Hospital, Third Military Medical University, Chongqing, China.
authors.forename: Jian
authors.initials: J
authors.lastname: Wang
authors.affiliation: Department of Radiology, Wayne State University, Detroit, Michigan, United States of America.
authors.forename: Jiani
authors.initials: J
authors.lastname: Hu
mesh_terms: D000328:Adult; D000368:Aged; D001808:Blood Vessels / Q000473:pathology; D006528:Carcinoma, Hepatocellular / Q000098:blood supply / Q000150:complications / Q000175:diagnosis* / Q000473:pathology*; D005260:Female; D006470:Hemorrhage / Q000150:complications; D006801:Humans; D008113:Liver Neoplasms / Q000098:blood supply / Q000150:complications / Q000175:diagnosis* / Q000473:pathology*; D008279:Magnetic Resonance Imaging / Q000379:methods*; D008297:Male; D008875:Middle Aged; D009361:Neoplasm Invasiveness; D011446:Prospective Studies