title: The usefulness of gadoxetic acid-enhanced dynamic magnetic resonance imaging in hepatocellular carcinoma: toward improved staging.
abstract: OBJECTIVE
  This study was designed to evaluate the usefulness of gadoxetic acid-enhanced dynamic magnetic resonance imaging (MRI) in staging hepatocellular carcinoma (HCC).
  
  
  METHODS
  This study was approved by the institutional review board of our institution. Two investigators independently and retrospectively reviewed dynamic computed tomography (CT) and gadoxetic acid-enhanced dynamic MRI obtained from July to September 2011 in 195 patients with HCC (158 men, 37 women; mean age, 57.1 years). The diagnostic performances of dynamic CT and MRI were evaluated. Barcelona Clinic Liver Cancer (BCLC) stages were determined before and after gadoxetic acid-enhanced dynamic MRI and according to final diagnosis. Change in BCLC stage was evaluated after adding gadoxetic acid-enhanced dynamic MRI to dynamic CT. Diagnostic performance and BCLC staging between the two modalities were compared using the McNemar test.
  
  
  RESULTS
  Final BCLC stage was classified as stage 0 in 25 patients (12.8%), A in 118 (60.5%), B in 33 (16.9%), C in 17 (8.7%), and D in 2 (1.0%). Compared with dynamic CT, gadoxetic acid-enhanced dynamic MRI showed significantly greater sensitivity (90.6% [203/224] vs. 79.5 % [178/224]; P < 0.0001) and significantly more accurate BCLC staging (92.8% [181/195] vs. 80.5% [157/195]; P < 0.0001). BCLC stage was changed correctly after gadoxetic acid-enhanced dynamic MRI in 13.8% (27/195) patients showing differences between CT and final BCLC stages.
  
  
  CONCLUSIONS
  Gadoxetic acid-enhanced dynamic MRI provided important additional information compared with dynamic CT during initial staging workups in patients with HCC. Gadoxetic acid-enhanced dynamic MRI showed higher diagnostic performance and more accurate BCLC staging than dynamic CT.
authors.affiliation: Department of Radiology and the Research Institute of Radiology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea, edwardchoi83@gmail.com.
authors.forename: Sang Hyun
authors.initials: SH
authors.lastname: Choi
authors.forename: Jae Ho
authors.initials: JH
authors.lastname: Byun
authors.forename: Heon-Ju
authors.initials: HJ
authors.lastname: Kwon
authors.forename: Hong Il
authors.initials: HI
authors.lastname: Ha
authors.forename: So Jung
authors.initials: SJ
authors.lastname: Lee
authors.forename: So Yeon
authors.initials: SY
authors.lastname: Kim
authors.forename: Hyung Jin
authors.initials: HJ
authors.lastname: Won
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; D005260:Female; D005500:Follow-Up Studies; D019786:Gadolinium DTPA; D006801:Humans; D008113:Liver Neoplasms / Q000175:diagnosis*; D008279:Magnetic Resonance Imaging / Q000379:methods*; D008297:Male; D008875:Middle Aged; D009367:Neoplasm Staging; D011379:Prognosis; D012189:Retrospective Studies
chemical_list: D003287:Contrast Media; C073590:gadolinium ethoxybenzyl DTPA; D019786:Gadolinium DTPA