title: MR imaging features for improved diagnosis of hepatocellular carcinoma in the non-cirrhotic liver: Multi-center evaluation.
abstract: OBJECTIVE
  To determine MR-imaging features for the differentiation between hepatocellular carcinoma (HCC) and benign hepatocellular tumors in the non-cirrhotic liver.
  
  
  METHODS
  107 consecutive patients without liver cirrhosis (46 male; 45 ± 14 years) who underwent liver resection due to suspicion of HCC were included in this multi-center study. The following imaging features were assessed: lesion diameter and demarcation, satellite-lesions, central-scar, capsule, fat-content, hemorrhage, vein-infiltration and signal-intensity (SI) on native T1-, T2- and dynamic-enhanced T1-weighted images (center versus periphery). In addition, contrast-media (CM) uptake in the liver specific phase was analyzed in a sub-group of 42 patients.
  
  
  RESULTS
  Significant differences between HCC (n=55) and benign lesions (n=52) were shown for native T1-, T2- and dynamic-enhanced T1-SI, fat-content, and satellite-lesions (all, P<.05). Independent predictors for HCC were T1-hypointensity (odds-ratio, 4.81), T2-hypo-/hyperintensity (5.07), lack of central tumor-enhancement (3.36), and satellite-lesions (5.78; all P<0.05). Sensitivity and specificity of HCC was 91% and 75% respectively for two out-of four independent predictors, whereas specificity reached 98% for all four predictors. Sub-analysis, showed significant differences in liver specific CM uptake between HCC (n=18) and benign lesions (n=24; P<0.001) and revealed lack of liver specific CM uptake (odds-ratio, 2.7) as additional independent feature for diagnosis of HCC.
  
  
  CONCLUSIONS
  Independent MRI features indicating HCC are T1-hypointensity, T2-hypo- or hyperintensity, lack of central tumor-enhancement, presence of satellite-lesions and lack of liver specific CM-uptake. These features may have the potential to improve the diagnosis of HCC in the non-cirrhotic liver.
authors.affiliation: Department of Diagnostic and Interventional Radiology, University Hospital Zurich, Zurich, Switzerland. Electronic address: michaelalexander.fischer@usz.ch.
authors.forename: M A
authors.initials: MA
authors.lastname: Fischer
authors.affiliation: Department of Visceral and Transplant Surgery, University Hospital Zurich, Zurich, Switzerland.
authors.forename: D A
authors.initials: DA
authors.lastname: Raptis
authors.affiliation: Department of Diagnostic and Interventional Radiology, University Hospital Zurich, Zurich, Switzerland.
authors.forename: O F
authors.initials: OF
authors.lastname: Donati
authors.affiliation: Department of Diagnostic and Interventional Radiology, University Hospital Zurich, Zurich, Switzerland.
authors.forename: R
authors.initials: R
authors.lastname: Hunziker
authors.affiliation: Department of Visceral and Transplant Surgery, University Hospital Zurich, Zurich, Switzerland.
authors.forename: E
authors.initials: E
authors.lastname: Schade
authors.affiliation: Department of Visceral and Transplant Surgery, University Hospital Essen, Essen, Germany.
authors.forename: G C
authors.initials: GC
authors.lastname: Sotiropoulos
authors.affiliation: Liver Transplant Unit, Auckland City Hospital, Auckland, New Zealand.
authors.forename: J
authors.initials: J
authors.lastname: McCall
authors.affiliation: Liver Transplant Unit, Auckland City Hospital, Auckland, New Zealand.
authors.forename: A
authors.initials: A
authors.lastname: Bartlett
authors.affiliation: Department of Visceral and Transplant Surgery, University Hospital Strasbourg, Strasbourg, France.
authors.forename: Ph
authors.initials: P
authors.lastname: Bachellier
authors.affiliation: Department of Surgery and Cancer, Hammersmith Hospital, Imperial College, London, UK.
authors.forename: A
authors.initials: A
authors.lastname: Frilling
authors.affiliation: Department of Visceral and Transplant Surgery, University Hospital Zurich, Zurich, Switzerland.
authors.forename: S
authors.initials: S
authors.lastname: Breitenstein
authors.affiliation: Department of Visceral and Transplant Surgery, University Hospital Zurich, Zurich, Switzerland.
authors.forename: P-A
authors.initials: PA
authors.lastname: Clavien
authors.affiliation: Department of Diagnostic and Interventional Radiology, University Hospital Zurich, Zurich, Switzerland.
authors.forename: H
authors.initials: H
authors.lastname: Alkadhi
authors.affiliation: Department of Diagnostic and Interventional Radiology, University Hospital Zurich, Zurich, Switzerland.
authors.forename: M A
authors.initials: MA
authors.lastname: Patak
mesh_terms: D018248:Adenoma, Liver Cell / Q000175:diagnosis / Q000473:pathology; D000328:Adult; D000368:Aged; D006528:Carcinoma, Hepatocellular / Q000175:diagnosis* / Q000473:pathology; D003287:Contrast Media / Q000008:administration & dosage; D003937:Diagnosis, Differential; D005260:Female; D020518:Focal Nodular Hyperplasia / Q000175:diagnosis / Q000473:pathology; D005500:Follow-Up Studies; D019786:Gadolinium DTPA / Q000008:administration & dosage; D006498:Hepatectomy / Q000379:methods; D006526:Hepatitis C / Q000150:complications; D006801:Humans; D007089:Image Enhancement / Q000379:methods*; D008099:Liver / Q000473:pathology; D008113:Liver Neoplasms / Q000175:diagnosis* / Q000473:pathology; D008279:Magnetic Resonance Imaging / Q000379:methods* / Q000706:statistics & numerical data; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D012680:Sensitivity and Specificity
chemical_list: D003287:Contrast Media; C073590:gadolinium ethoxybenzyl DTPA; D019786:Gadolinium DTPA
keywords: Adenoma, liver cell, focal nodular hyperplasia; Carcinoma, hepatocellular; Liver neoplasms; Magnetic resonance imaging