title: Diagnostic Accuracy of Preoperative Gadoxetic Acid-enhanced 3-T MR Imaging for Malignant Liver Lesions by Using Ex Vivo MR Imaging-matched Pathologic Findings as the Reference Standard.
abstract: OBJECTIVE
  To determine per-lesion sensitivity and positive predictive value (PPV) of gadoxetic acid-enhanced 3-T magnetic resonance (MR) imaging for the diagnosis of malignant lesions by using matched (spatially correlated) hepatectomy pathologic findings as the reference standard. Materials and
  
  
  METHODS
  In this prospective, institutional review board-approved, HIPAA-compliant study, 20 patients (nine men, 11 women; mean age, 59 years) with malignant liver lesions who gave written informed consent underwent preoperative gadoxetic acid-enhanced 3-T MR imaging for surgical planning. Two image sets were independently analyzed by three readers to detect liver lesions (set 1 without and set 2 with hepatobiliary phase [HBP] images). Hepatectomy specimen ex vivo MR imaging assisted in matching gadoxetic acid-enhanced 3-T MR imaging findings with pathologic findings. Interreader agreement was assessed by using the Cohen κ coefficient. Per-lesion sensitivity and PPV were calculated.
  
  
  RESULTS
  Cohen κ values were 0.64-0.76 and 0.57-0.84, and overall per-lesion sensitivity was 45% (42 of 94 lesions) to 56% (53 of 94 lesions) and 58% (55 of 94 lesions) to 64% (60 of 94 lesions) for sets 1 and 2, respectively. The addition of HBP imaging did not affect interreader agreement but significantly improved overall sensitivity for one reader (P < .05) and almost for another (P = .05). Sensitivity for 0.2-0.5-cm lesions was 0% (0 of 26 lesions) to 8% (two of 26 lesions) for set 1 and 4% (one of 26 lesions) to 12% (three of 26 lesions) for set 2. Sensitivity for 0.6-1.0-cm lesions was 28% (nine of 32 lesions) to 59% (19 of 32 lesions) for set 1 and 66% (21 of 32 lesions) to 69% (22 of 32 lesions) for set 2. Sensitivity for lesions at least 1.0 cm in diameter was at least 81% (13 of 16 lesions) for set 1 and was not improved for set 2. PPV was 98% (56 of 57 lesions) to 100% (60 of 60 lesions) for all readers without differences between image sets or lesion size.
  
  
  CONCLUSIONS
  Gadoxetic acid-enhanced 3-T MR imaging provides high per-lesion sensitivity and PPV for preoperative malignant liver lesion detection overall, although sensitivity for 0.2-0.5-cm malignant lesions is poor.
authors: From the Liver Imaging Group, Department of Radiology, University of California-San Diego, 408 Dickinson St, San Diego, CA 92103-8226 (E.A.C.C., G.M.C., E.S., I.C., A.T., R.M.M., L.C., M.S.M., C.B.S.); Department of Radiology, Naval Medical Center San Diego, San Diego, Calif (R.M.M.); Computational and Applied Statistics Laboratory, San Diego Supercomputer Center, University of California-San Diego, San Diego, Calif (T.W., A.G.); Department of Surgery and Moores Cancer Center, University of California-San Diego, San Diego, Calif (J.K.S., A.H.); and Western Washington Pathology and Multicare Health System, Tacoma, Wash (M.R.P.).
authors: Eduardo A C
authors: EA
authors: Costa
authors: From the Liver Imaging Group, Department of Radiology, University of California-San Diego, 408 Dickinson St, San Diego, CA 92103-8226 (E.A.C.C., G.M.C., E.S., I.C., A.T., R.M.M., L.C., M.S.M., C.B.S.); Department of Radiology, Naval Medical Center San Diego, San Diego, Calif (R.M.M.); Computational and Applied Statistics Laboratory, San Diego Supercomputer Center, University of California-San Diego, San Diego, Calif (T.W., A.G.); Department of Surgery and Moores Cancer Center, University of California-San Diego, San Diego, Calif (J.K.S., A.H.); and Western Washington Pathology and Multicare Health System, Tacoma, Wash (M.R.P.).
authors: Guilherme M
authors: GM
authors: Cunha
authors: From the Liver Imaging Group, Department of Radiology, University of California-San Diego, 408 Dickinson St, San Diego, CA 92103-8226 (E.A.C.C., G.M.C., E.S., I.C., A.T., R.M.M., L.C., M.S.M., C.B.S.); Department of Radiology, Naval Medical Center San Diego, San Diego, Calif (R.M.M.); Computational and Applied Statistics Laboratory, San Diego Supercomputer Center, University of California-San Diego, San Diego, Calif (T.W., A.G.); Department of Surgery and Moores Cancer Center, University of California-San Diego, San Diego, Calif (J.K.S., A.H.); and Western Washington Pathology and Multicare Health System, Tacoma, Wash (M.R.P.).
authors: Emmanuil
authors: E
authors: Smorodinsky
authors: From the Liver Imaging Group, Department of Radiology, University of California-San Diego, 408 Dickinson St, San Diego, CA 92103-8226 (E.A.C.C., G.M.C., E.S., I.C., A.T., R.M.M., L.C., M.S.M., C.B.S.); Department of Radiology, Naval Medical Center San Diego, San Diego, Calif (R.M.M.); Computational and Applied Statistics Laboratory, San Diego Supercomputer Center, University of California-San Diego, San Diego, Calif (T.W., A.G.); Department of Surgery and Moores Cancer Center, University of California-San Diego, San Diego, Calif (J.K.S., A.H.); and Western Washington Pathology and Multicare Health System, Tacoma, Wash (M.R.P.).
authors: Irene
authors: I
authors: Cruite
authors: From the Liver Imaging Group, Department of Radiology, University of California-San Diego, 408 Dickinson St, San Diego, CA 92103-8226 (E.A.C.C., G.M.C., E.S., I.C., A.T., R.M.M., L.C., M.S.M., C.B.S.); Department of Radiology, Naval Medical Center San Diego, San Diego, Calif (R.M.M.); Computational and Applied Statistics Laboratory, San Diego Supercomputer Center, University of California-San Diego, San Diego, Calif (T.W., A.G.); Department of Surgery and Moores Cancer Center, University of California-San Diego, San Diego, Calif (J.K.S., A.H.); and Western Washington Pathology and Multicare Health System, Tacoma, Wash (M.R.P.).
authors: An
authors: A
authors: Tang
authors: From the Liver Imaging Group, Department of Radiology, University of California-San Diego, 408 Dickinson St, San Diego, CA 92103-8226 (E.A.C.C., G.M.C., E.S., I.C., A.T., R.M.M., L.C., M.S.M., C.B.S.); Department of Radiology, Naval Medical Center San Diego, San Diego, Calif (R.M.M.); Computational and Applied Statistics Laboratory, San Diego Supercomputer Center, University of California-San Diego, San Diego, Calif (T.W., A.G.); Department of Surgery and Moores Cancer Center, University of California-San Diego, San Diego, Calif (J.K.S., A.H.); and Western Washington Pathology and Multicare Health System, Tacoma, Wash (M.R.P.).
authors: Robert M
authors: RM
authors: Marks
authors: From the Liver Imaging Group, Department of Radiology, University of California-San Diego, 408 Dickinson St, San Diego, CA 92103-8226 (E.A.C.C., G.M.C., E.S., I.C., A.T., R.M.M., L.C., M.S.M., C.B.S.); Department of Radiology, Naval Medical Center San Diego, San Diego, Calif (R.M.M.); Computational and Applied Statistics Laboratory, San Diego Supercomputer Center, University of California-San Diego, San Diego, Calif (T.W., A.G.); Department of Surgery and Moores Cancer Center, University of California-San Diego, San Diego, Calif (J.K.S., A.H.); and Western Washington Pathology and Multicare Health System, Tacoma, Wash (M.R.P.).
authors: Lisa
authors: L
authors: Clark
authors: From the Liver Imaging Group, Department of Radiology, University of California-San Diego, 408 Dickinson St, San Diego, CA 92103-8226 (E.A.C.C., G.M.C., E.S., I.C., A.T., R.M.M., L.C., M.S.M., C.B.S.); Department of Radiology, Naval Medical Center San Diego, San Diego, Calif (R.M.M.); Computational and Applied Statistics Laboratory, San Diego Supercomputer Center, University of California-San Diego, San Diego, Calif (T.W., A.G.); Department of Surgery and Moores Cancer Center, University of California-San Diego, San Diego, Calif (J.K.S., A.H.); and Western Washington Pathology and Multicare Health System, Tacoma, Wash (M.R.P.).
authors: Tanya
authors: T
authors: Wolfson
authors: From the Liver Imaging Group, Department of Radiology, University of California-San Diego, 408 Dickinson St, San Diego, CA 92103-8226 (E.A.C.C., G.M.C., E.S., I.C., A.T., R.M.M., L.C., M.S.M., C.B.S.); Department of Radiology, Naval Medical Center San Diego, San Diego, Calif (R.M.M.); Computational and Applied Statistics Laboratory, San Diego Supercomputer Center, University of California-San Diego, San Diego, Calif (T.W., A.G.); Department of Surgery and Moores Cancer Center, University of California-San Diego, San Diego, Calif (J.K.S., A.H.); and Western Washington Pathology and Multicare Health System, Tacoma, Wash (M.R.P.).
authors: Anthony
authors: A
authors: Gamst
authors: From the Liver Imaging Group, Department of Radiology, University of California-San Diego, 408 Dickinson St, San Diego, CA 92103-8226 (E.A.C.C., G.M.C., E.S., I.C., A.T., R.M.M., L.C., M.S.M., C.B.S.); Department of Radiology, Naval Medical Center San Diego, San Diego, Calif (R.M.M.); Computational and Applied Statistics Laboratory, San Diego Supercomputer Center, University of California-San Diego, San Diego, Calif (T.W., A.G.); Department of Surgery and Moores Cancer Center, University of California-San Diego, San Diego, Calif (J.K.S., A.H.); and Western Washington Pathology and Multicare Health System, Tacoma, Wash (M.R.P.).
authors: Jason K
authors: JK
authors: Sicklick
authors: From the Liver Imaging Group, Department of Radiology, University of California-San Diego, 408 Dickinson St, San Diego, CA 92103-8226 (E.A.C.C., G.M.C., E.S., I.C., A.T., R.M.M., L.C., M.S.M., C.B.S.); Department of Radiology, Naval Medical Center San Diego, San Diego, Calif (R.M.M.); Computational and Applied Statistics Laboratory, San Diego Supercomputer Center, University of California-San Diego, San Diego, Calif (T.W., A.G.); Department of Surgery and Moores Cancer Center, University of California-San Diego, San Diego, Calif (J.K.S., A.H.); and Western Washington Pathology and Multicare Health System, Tacoma, Wash (M.R.P.).
authors: Alan
authors: A
authors: Hemming
authors: From the Liver Imaging Group, Department of Radiology, University of California-San Diego, 408 Dickinson St, San Diego, CA 92103-8226 (E.A.C.C., G.M.C., E.S., I.C., A.T., R.M.M., L.C., M.S.M., C.B.S.); Department of Radiology, Naval Medical Center San Diego, San Diego, Calif (R.M.M.); Computational and Applied Statistics Laboratory, San Diego Supercomputer Center, University of California-San Diego, San Diego, Calif (T.W., A.G.); Department of Surgery and Moores Cancer Center, University of California-San Diego, San Diego, Calif (J.K.S., A.H.); and Western Washington Pathology and Multicare Health System, Tacoma, Wash (M.R.P.).
authors: Michael R
authors: MR
authors: Peterson
authors: From the Liver Imaging Group, Department of Radiology, University of California-San Diego, 408 Dickinson St, San Diego, CA 92103-8226 (E.A.C.C., G.M.C., E.S., I.C., A.T., R.M.M., L.C., M.S.M., C.B.S.); Department of Radiology, Naval Medical Center San Diego, San Diego, Calif (R.M.M.); Computational and Applied Statistics Laboratory, San Diego Supercomputer Center, University of California-San Diego, San Diego, Calif (T.W., A.G.); Department of Surgery and Moores Cancer Center, University of California-San Diego, San Diego, Calif (J.K.S., A.H.); and Western Washington Pathology and Multicare Health System, Tacoma, Wash (M.R.P.).
authors: Michael S
authors: MS
authors: Middleton
authors: From the Liver Imaging Group, Department of Radiology, University of California-San Diego, 408 Dickinson St, San Diego, CA 92103-8226 (E.A.C.C., G.M.C., E.S., I.C., A.T., R.M.M., L.C., M.S.M., C.B.S.); Department of Radiology, Naval Medical Center San Diego, San Diego, Calif (R.M.M.); Computational and Applied Statistics Laboratory, San Diego Supercomputer Center, University of California-San Diego, San Diego, Calif (T.W., A.G.); Department of Surgery and Moores Cancer Center, University of California-San Diego, San Diego, Calif (J.K.S., A.H.); and Western Washington Pathology and Multicare Health System, Tacoma, Wash (M.R.P.).
authors: Claude B
authors: CB
authors: Sirlin
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D003287:Contrast Media; D003430:Cross-Sectional Studies; D005260:Female; D019786:Gadolinium DTPA; D006801:Humans; D008113:Liver Neoplasms / Q000473:pathology* / Q000601:surgery*; D008279:Magnetic Resonance Imaging / Q000379:methods*; D008297:Male; D008875:Middle Aged; D011237:Predictive Value of Tests; D011300:Preoperative Care; D011446:Prospective Studies; D012015:Reference Standards; D015203:Reproducibility of Results; D012680:Sensitivity and Specificity; D055815:Young Adult
chemical_list: D003287:Contrast Media; C073590:gadolinium ethoxybenzyl DTPA; D019786:Gadolinium DTPA