title: The utility of gadoxetic acid-enhanced MR imaging to characterize atypical cirrhotic nodules detected on dynamic CT images.
abstract: OBJECTIVE
  To evaluate whether gadoxetic acid (Gd-EOB-DTPA)-enhanced MR images of tumors taken during the hepatocyte-specific phase can aid in the differentiation between hepatocellular carcinoma (HCC) and dysplastic nodules (DNs) in patients with atypical cirrhotic nodules detected on dynamic CT images.
  
  
  METHODS
  Seventy-one patients with 112 nodules showing atypical dynamic enhancement on CT images underwent gadoxetic acid-enhanced MR imaging (MRI) studies. Using a reference standard, we determined that 33 of the nodules were DNs and that 79 were true HCCs. Tumor size, signal intensity on precontrast T1-weighted images (T1WI) and T2WI, and the pattern of dynamic enhancement on MR images taken in the hepatocyte-phase were determined.
  
  
  RESULTS
  There were significant differences in tumor size, hyperintensity on T2WI, hypointensity on T1WI, typical HCC enhancement pattern on dynamic MR images, or hypointensity on hepatocyte-phase images between DNs and HCC. The sensitivity and specificity were 60.8% and 87.9% for T2WI, 38.0% and 87.9% for T1WI, 17.7% and 100% for dynamic MR imaging, 83.5% and 84.9% for hepatocyte-phase imaging, and 60.8% and 87.9% for tumor size (threshold of 1.7 cm).
  
  
  CONCLUSIONS
  Gd-EOB-DTPA-enhanced hepatocyte-phase imaging is recommended for patients at high risk of HCC who present with atypical lesions on dynamic CT images.
authors.affiliation: Department of Biomedical Imaging and Radiological Science, National Yang-Ming Medical University, Taipei, Taiwan; Department of Radiology, Chang-Hua Christian Hospital, Changhua, Taiwan.
authors.forename: Chen-Te
authors.initials: CT
authors.lastname: Chou
authors.affiliation: Department of Biomedical Imaging and Radiological Science, National Yang-Ming Medical University, Taipei, Taiwan.
authors.forename: Wen-Pei
authors.initials: WP
authors.lastname: Wu
authors.affiliation: Department of Radiology, Chang-Hua Christian Hospital, Changhua, Taiwan.
authors.forename: Chia-Bang
authors.initials: CB
authors.lastname: Chen
authors.affiliation: Department of Gastroenterology, Chang-Hua Christian Hospital, Changhua, Taiwan.
authors.forename: Wei-Wen
authors.initials: WW
authors.lastname: Su
authors.affiliation: Department of Biomedical Imaging and Radiological Science, National Yang-Ming Medical University, Taipei, Taiwan; Department of Radiology, Taipei City Hospital, Taipei, Taiwan.
authors.forename: Ran-Chou
authors.initials: RC
authors.lastname: Chen
authors.affiliation: Transplantation Medicine and Surgery Research Centre, Chang-Hua Christian Hospital, Changhua, Taiwan; School of Medicine, Chung Shan Medical University, Taichung, Taiwan; School of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan.
authors.forename: Yao-Li
authors.initials: YL
authors.lastname: Chen
mesh_terms: D000368:Aged; D006528:Carcinoma, Hepatocellular / Q000473:pathology*; D003937:Diagnosis, Differential; D005260:Female; D019786:Gadolinium DTPA; D006801:Humans; D007089:Image Enhancement / Q000379:methods*; D008103:Liver Cirrhosis / Q000473:pathology*; D008113:Liver Neoplasms / Q000473:pathology*; D008279:Magnetic Resonance Imaging / Q000379:methods*; D008297:Male; D008875:Middle Aged; D012680:Sensitivity and Specificity
chemical_list: C073590:gadolinium ethoxybenzyl DTPA; D019786:Gadolinium DTPA