Detection of Hepatocellular Carcinoma: Comparison of Gadoxetic Acid-Enhanced MRI, Diffusion-Weighted Imaging, and Combined Interpretation at 3 T MRI1

Abstract

Purpose To compare diffusion-weighted imaging (DWI) and gadoxetic acid-enhanced (Gdx) magnetic resonance imaging (MRI), whether alone or in combination, for the detection of hepatocellular carcinoma (HCC) by using 3 T.

Materials and Methods 84 HCCs in 66 patients (57 men, 9 women; mean age 69.2 years) were examined using 3 T MRI. DWI (b values 0, 50, and 800 sec/mm2) and dynamic gadoxetic acid-enhanced MRI as well as hepatobiliary phase were performed. Images were retrospectively reviewed by two radiologists to compare the diagnostic performances of DWI and Gdx MRI alone and in combination for the detection of HCC. Alternative free response receiver operating characteristic analysis and comparison of sensitivities were used for statistical analysis.

Results The sensitivity of Gdx set (73/84, 87%) was significantly higher than that of DWI set (60.5/84, 72%) for both observers. The Az values of DWI and Gdx MRI for the detection of HCC were not statistically significant for either observer (Az for DWI = 0.818 and 0.864, Az for Gdx MR = 0.902 and 0.842, respectively, p = 0.107 for observer 1 and p = 0.738 for observer 2). The combination of both techniques did not increase the sensitivities of detecting HCC in either observer. When lesions smaller than 2 cm were considered, the DWI set yielded a significantly lower sensitivity as compared with either the Gdx set alone or the combination set.

Conclusion Gadoxetic acid-enhanced MRI was better than DWI for detection the HCC by using 3 T MRI. The combination of DWI and Gdx MRI did not contribute to the successful detection of HCC.