title: Pretransplant diagnosis of hepatocellular carcinoma by gadoxetic acid-enhanced and diffusion-weighted magnetic resonance imaging.
abstract: We sought to evaluate the diagnostic performance of gadoxetic acid-enhanced magnetic resonance imaging (MRI) with and without additional diffusion-weighted imaging (DWI) in the detection of hepatocellular carcinoma (HCC) in pretransplant patients. We included 63 liver transplant patients (54 men and 9 women; mean age = 52 years) who had undergone gadoxetic acid-enhanced MRI with DWI at 3.0 T within 90 days before transplantation. Two image sets were reviewed for HCC in 2 separate sessions by 2 independent observers: the gadoxetic acid set and the combined set (gadoxetic acid plus DWI). The sensitivity, specificity, positive predictive value, and negative predictive value were calculated for each image set. In all, 113 HCCs (size range = 0.5-7.8 cm, mean = 2.0 ± 1.3 cm) were identified in the 52 liver explants. The per-lesion sensitivity of the combined set (78.8% for both observers) was higher than the sensitivity of the gadoxetic acid set [71.7% (P = 0.02) and 72.6% (P = 0.03) for the 2 observers], with the highest trend for Child-Pugh class A (94.4% and 97.2% for gadoxetic acid and 97.2% for combined), which was followed by class B (73.2% for gadoxetic acid and 82.9% for combined) and then class C (47.2% for gadoxetic acid and 55.6% for combined, P = 0.01). The per-patient negative predictive value of the combined set was higher than that of the gadoxetic acid set for both observers (P = 0.046). There was no difference in specificity between the 2 image sets (P > 0.05). The addition of DWI to gadoxetic acid-enhanced MRI resulted in significantly higher sensitivity to detect HCC. However, the sensitivity decreased with increasing cirrhosis severity for both imaging types.
authors.affiliation: Department of Radiology, Soonchunhyang University Seoul Hospital, Seoul, Republic of Korea.
authors.forename: Jiyoung
authors.initials: J
authors.lastname: Hwang
authors.forename: Young Kon
authors.initials: YK
authors.lastname: Kim
authors.forename: Jong Man
authors.initials: JM
authors.lastname: Kim
authors.forename: Won Jae
authors.initials: WJ
authors.lastname: Lee
authors.forename: Dongil
authors.initials: D
authors.lastname: Choi
authors.forename: Seong Sook
authors.initials: SS
authors.lastname: Hong
mesh_terms: D000328:Adult; D000368:Aged; D006528:Carcinoma, Hepatocellular / Q000175:diagnosis* / Q000473:pathology; D003287:Contrast Media / Q000737:chemistry; D038524:Diffusion Magnetic Resonance Imaging; D005260:Female; D019786:Gadolinium DTPA; D006801:Humans; D007091:Image Processing, Computer-Assisted; D008113:Liver Neoplasms / Q000175:diagnosis* / Q000473:pathology; D016031:Liver Transplantation; D008297:Male; D008875:Middle Aged; D015588:Observer Variation; D011237:Predictive Value of Tests; D015203:Reproducibility of Results; D012189:Retrospective Studies; D012680:Sensitivity and Specificity
chemical_list: D003287:Contrast Media; C073590:gadolinium ethoxybenzyl DTPA; D019786:Gadolinium DTPA