title: Appearance of hepatocellular carcinoma on gadoxetic acid-enhanced hepato-biliary phase MR imaging: a systematic review.
abstract: OBJECTIVE
  To perform a systematic review of the contrast behaviour of HCC on Gd-EOB-DTPA hepato-biliary phase MRI.
  
  
  METHODS
  This review was completed in accordance with the recommendations outlined in the preferred reporting items for systematic reviews statement. In all reports, qualitative analysis of signal intensity (SI) of HCC on hepato-biliary phase was performed: the relative SI of HCC. When available, a quantitative analysis of tumour enhancement was evaluated.
  
  
  RESULTS
  A total of 106 studies were retrieved, of which 41 met the inclusion criteria. The total number of patients was 2550, with 3132 HCC. MRI showed 3110 HCC (22 non-detected). 2692/3110 (87 %) HCC were hypointense on Gd-EOB-DTPA-enhanced hepatocyte-phase MRI, 134 (4 %) isointense; 106 (3 %) hyperintense and 178 (6 %) iso-hyperintense. In 26 articles, 1653 HCCs were classified as follows: 519 well-differentiated, 883 moderately differentiated, 251 poorly differentiated. Among well-differentiated HCC, 445 (86 %) were hypointense, 12 isointense (2 %), 9 hyperintense (2 %), 53 iso/hyperintense (10 %). Among moderately differentiated HCC, 774 (88 %) were hypointense, 8 isointense (1 %), 27 hyperintense (3 %), 74 iso/hyperintense (8 %). Among poorly differentiated HCCs, 245 (98 %) were hypointense, one isointense, one hyperintense and four iso-hyperintense (2 %). We found a Chi-square (χ (2)) equivalent to 25,082 (p < 0.001).
  
  
  CONCLUSIONS
  The percentage of lesions iso/hyper/iso-hyper is the same when considering well-differentiated and moderately differentiated HCC; when considering poorly differentiated HCC, the percentage of lesions iso/hyper/iso-hyper is significantly lower. Conversely, the percentage of lesions hypointense is significantly more represented in poorly differentiated HCC compared to well-differentiated and moderately differentiated HCC.
authors.affiliation: Department of Advanced Biomedical Sciences, University "Federico II", Naples, Italy.
authors.forename: Paola
authors.initials: P
authors.lastname: Erra
authors.affiliation: Department of Advanced Biomedical Sciences, University "Federico II", Naples, Italy.
authors.forename: Marta
authors.initials: M
authors.lastname: Puglia
authors.affiliation: Department of Radiology, Ospedale S.M. delle Grazie, Pozzuoli, Napoli, Italy.
authors.forename: Alfonso
authors.initials: A
authors.lastname: Ragozzino
authors.affiliation: Department of Advanced Biomedical Sciences, University "Federico II", Naples, Italy.
authors.forename: Simone
authors.initials: S
authors.lastname: Maurea
authors.affiliation: Institute of Bio-structure and Bio-Imaging of the National Research Council (CNR), Naples, Italy.
authors.forename: Raffaele
authors.initials: R
authors.lastname: Liuzzi
authors.affiliation: Department of Advanced Biomedical Sciences, University "Federico II", Naples, Italy.
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Sabino
authors.affiliation: Department of Advanced Biomedical Sciences, University "Federico II", Naples, Italy.
authors.forename: Luigi
authors.initials: L
authors.lastname: Barbuto
authors.affiliation: Department of Advanced Biomedical Sciences, University "Federico II", Naples, Italy.
authors.forename: Alberto
authors.initials: A
authors.lastname: Cuocolo
authors.affiliation: Department of Advanced Biomedical Sciences, University "Federico II", Naples, Italy. mimbriaco@hotmail.com.|Department of Radiology, Ospedale S.M. delle Grazie, Pozzuoli, Napoli, Italy. mimbriaco@hotmail.com.
authors.forename: Massimo
authors.initials: M
authors.lastname: Imbriaco
mesh_terms: D006528:Carcinoma, Hepatocellular / Q000175:diagnosis* / Q000473:pathology; D003287:Contrast Media; D019786:Gadolinium DTPA; D006801:Humans; D008113:Liver Neoplasms / Q000175:diagnosis* / Q000473:pathology; D008279:Magnetic Resonance Imaging / Q000379:methods*
chemical_list: D003287:Contrast Media; C073590:gadolinium ethoxybenzyl DTPA; D019786:Gadolinium DTPA
keywords: Contrast medium; HCC; Liver