Highlights
- •Arterial subtraction images show more arterial hyperenhancement than arterial images.
- •Arterial subtraction images significantly increase sensitivity for the diagnosis of HCC.
- •Arterial subtraction images do not significantly decrease specificity.
- •Arterial subtraction images can be useful for diagnosing early-stage HCC.
Abstract
Background & Aims
Although gadoxetate disodium-enhanced magnetic resonance imaging (MRI) shows higher
sensitivity for diagnosing hepatocellular carcinoma (HCC), its arterial-phase images
may be unsatisfactory because of weak arterial enhancement. We investigated the clinical
effectiveness of arterial subtraction images from gadoxetate disodium-enhanced MRI
for diagnosing early-stage HCC using the Liver Imaging Reporting and Data System (LI-RADS)
v2018.
Methods
In 258 patients at risk of HCC who underwent gadoxetate disodium-enhanced MRI in 2016,
a total of 372 hepatic nodules (273 HCCs, 18 other malignancies, and 81 benign nodules)
of 3.0 cm or smaller were retrospectively analyzed. Final diagnosis was assessed histopathologically
or clinically (marginal recurrence after treatment or change in lesion size on follow-up
imaging). The detection rate for arterial hyperenhancement was compared between ordinary
arterial-phase and arterial subtraction images, and the benefit of arterial subtraction
images in diagnosing HCC using LI-RADS was assessed.
Results
Arterial subtraction images had a significantly higher detection rate for arterial
hyperenhancement than ordinary arterial-phase images, both for all hepatic nodules
(72.3% vs. 62.4%, p <0.001) and HCCs (91.9% vs. 80.6%, p <0.001). Compared with ordinary arterial-phase images, arterial subtraction images significantly
increased the sensitivity of LI-RADS category 5 for diagnosis of HCC (64.1% [173/270]
vs. 55.9% [151/270], p <0.001), without significantly decreasing specificity (92.9% [91/98] vs. 94.9% [93/98], p = 0.155). For histopathologically confirmed lesions, arterial subtraction images
significantly increased sensitivity to 68.8% (128/186) from the 61.3% (114/186) of
ordinary arterial-phase images (p <0.001), with a minimal decrease in specificity to 84.8% (39/46) from 89.1% (41/46) (p = 0.151).
Conclusions
Arterial subtraction images of gadoxetate disodium-enhanced MRI can significantly
improve the sensitivity of early-stage HCC diagnosis using LI-RADS, without a significant
decrease in specificity.
Lay summary
Gadoxetate disodium-enhanced magnetic resonance imaging is an imaging technique with
a high sensitivity for the diagnosis of hepatocellular carcinoma. However, arterial-phase
images may be unsatisfactory because of weak arterial enhancement. We found that using
arterial subtraction images led to clinically meaningful improvements in the diagnosis
of early-stage hepatocellular carcinoma.
Graphical abstract
Graphical Abstract
Keywords
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Article info
Publication history
Published online: May 17, 2019
Accepted:
May 3,
2019
Received in revised form:
April 1,
2019
Received:
December 18,
2018
Identification
Copyright
© 2019 European Association for the Study of the Liver. Published by Elsevier B.V. All rights reserved.
