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Extended application of subtraction arterial phase imaging in LI-RADS version 2018: a strategy to improve the diagnostic performance for hepatocellular carcinoma on gadoxetate disodium-enhanced MRI

Authors
 Seung-Seob Kim  ;  Sunyoung Lee  ;  Heejin Bae  ;  Yong Eun Chung  ;  Jin-Young Choi  ;  Mi-Suk Park  ;  Myeong-Jin Kim 
Citation
 EUROPEAN RADIOLOGY, Vol.31(3) : 1620-1629, 2021-03 
Journal Title
 EUROPEAN RADIOLOGY 
ISSN
 0938-7994 
Issue Date
2021-03
MeSH
Carcinoma, Hepatocellular* / diagnostic imaging ; Contrast Media ; Gadolinium DTPA ; Humans ; Liver Neoplasms* / diagnostic imaging ; Magnetic Resonance Imaging ; Retrospective Studies ; Sensitivity and Specificity
Keywords
Diagnosis ; Liver neoplasms ; Magnetic resonance imaging ; Sensitivity and specificity ; Subtraction technique
Abstract
Objectives: This study aimed to assess the detection of hepatocellular carcinoma (HCC) utilizing subtraction AP (arterial phase) imaging only for T1 hyperintense observations compared with the detection of HCC on subtraction AP imaging that included T1 hyper-, iso-, and hypointense lesions on gadoxetate disodium-enhanced MRI. Materials and methods: This retrospective study included 234 patients (311 observations including 239 HCCs) at high risk for HCC who underwent gadoxetate disodium-enhanced MRI with subtraction AP imaging between 2015 and 2017. Arterial phase hyperenhancement (APHE) was divided into two subtypes: conventional APHE, where subtraction AP imaging is used to detect APHE only for T1 hyperintense observations; and modified APHE, where subtraction AP imaging is applied to T1 hyper-, iso-, and hypointense lesions. Two readers independently reviewed all observations and the per-observation diagnostic performances were compared using McNemar's test. Results: Modified nonrim APHE showed significantly higher sensitivity than conventional nonrim APHE (90.0% vs 82.8%; p < 0.001) for diagnosing HCC, without a significant difference in specificity (66.7% vs 68.1%; p > 0.999). The LR-5 category with modified nonrim APHE provided better sensitivity than the LR-5 with conventional nonrim APHE (70.3% vs 63.2%; p < 0.001), without a significant decrease in specificity (94.4% vs 95.8%; p > 0.999). Conclusion: Extended application of subtraction AP imaging for T1 hypo- or isointense observations on gadoxetate disodium-enhanced MRI can improve sensitivity in the diagnosis of HCC without a significant difference in specificity. Key points: • Modified nonrim arterial phase hyperenhancement (APHE), extended application of subtraction arterial phase imaging for T1 hypo- or isointense observation, outperforms conventional nonrim APHE. • The LR-5 category with modified nonrim APHE provided better sensitivity in diagnosing HCC than the LR-5 with conventional APHE, without a significant decrease in specificity.
Full Text
https://link.springer.com/article/10.1007%2Fs00330-020-07229-2
DOI
10.1007/s00330-020-07229-2
Appears in Collections:
1. College of Medicine (의과대학) > Dept. of Radiology (영상의학교실) > 1. Journal Papers
Yonsei Authors
Kim, Myeong Jin(김명진) ORCID logo https://orcid.org/0000-0001-7949-5402
Kim, Seung-seob(김승섭) ORCID logo https://orcid.org/0000-0001-6071-306X
Park, Mi-Suk(박미숙) ORCID logo https://orcid.org/0000-0001-5817-2444
Bae, Heejin(배희진) ORCID logo https://orcid.org/0000-0002-1227-8646
Lee, Sunyoung(이선영) ORCID logo https://orcid.org/0000-0002-6893-3136
Chung, Yong Eun(정용은) ORCID logo https://orcid.org/0000-0003-0811-9578
Choi, Jin Young(최진영) ORCID logo https://orcid.org/0000-0002-9025-6274
URI
https://ir.ymlib.yonsei.ac.kr/handle/22282913/182206
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