title: Differentiation of small (≤2 cm) hepatocellular carcinomas from small benign nodules in cirrhotic liver on gadoxetic acid-enhanced and diffusion-weighted magnetic resonance images.
abstract: OBJECTIVE
  To identify imaging characteristics that differentiate small (≤2 cm) HCCs from small (≤2 cm) benign nodules in cirrhotic liver on gadoxetic acid-enhanced and diffusion-weighted (DW) magnetic resonance (MR) images.
  
  
  METHODS
  On gadoxetic acid-enhanced and DW MR images, we analysed signal intensity of 222 small HCCs and 61 benign nodules (diameter, 0.5-2 cm) at each sequence and rim enhancement during portal or equilibrium phases. Univariate and multivariate logistic regression analyses identified predictors of HCC. Combinations of significant MR findings in multivariate analysis were compared with American Association for the Study of Liver Disease (AASLD) practice guidelines.
  
  
  RESULTS
  In multivariate analysis, arterial enhancement (adjusted odds ratio [aOR], 8.6), T2 hyperintensity (aOR, 5.8), and hyperintensity on DW images (aOR, 3.8) were significant for differentiating small HCCs from benign nodules (p ≤ 0.004). When two or all three findings were applied as diagnostic criteria for differentiating small HCCs from benign nodules, sensitivity and accuracy were significantly higher compared with AASLD practice guidelines (91% vs. 78% and 89% vs. 81%, respectively; each p < 0.0001).
  
  
  CONCLUSIONS
  On gadoxetic acid-enhanced MR imaging, arterial enhancement and hyperintensity on T2-weighted and DW MR images are helpful for differentiating small HCCs from benign nodules in liver cirrhosis.
authors.affiliation: Department of Radiology and Research Institute of Radiology, Asan Medical Center, University of Ulsan College of Medicine, Asanbyeongwon-gil 86, Songpa-ku, Seoul, 138-736, Korea.
authors.forename: Heon-Ju
authors.initials: HJ
authors.lastname: Kwon
authors.forename: Jae Ho
authors.initials: JH
authors.lastname: Byun
authors.forename: Ji Yeon
authors.initials: JY
authors.lastname: Kim
authors.forename: Gil-Sun
authors.initials: GS
authors.lastname: Hong
authors.forename: Hyung Jin
authors.initials: HJ
authors.lastname: Won
authors.forename: Yong Moon
authors.initials: YM
authors.lastname: Shin
authors.forename: Pyo Nyun
authors.initials: PN
authors.lastname: Kim
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D006528:Carcinoma, Hepatocellular / Q000175:diagnosis*; D003287:Contrast Media; D003937:Diagnosis, Differential; D038524:Diffusion Magnetic Resonance Imaging; D005260:Female; D019786:Gadolinium DTPA; D006801:Humans; D007089:Image Enhancement; D008099:Liver / Q000473:pathology; D008103:Liver Cirrhosis / Q000175:diagnosis*; D008113:Liver Neoplasms / Q000175:diagnosis*; D008297:Male; D008875:Middle Aged; D012680:Sensitivity and Specificity
chemical_list: D003287:Contrast Media; C073590:gadolinium ethoxybenzyl DTPA; D019786:Gadolinium DTPA