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Corona enhancement can substitute enhancing capsule in the imaging diagnosis of small (≤ 3 cm) HCCs on gadoxetic acid-enhanced MRI

 Ju Hyun Ham  ;  Jeong-Sik Yu  ;  Jeong Min Choi  ;  Eun-Suk Cho  ;  Joo Hee Kim  ;  Jae-Joon Chung 
 EUROPEAN RADIOLOGY, Vol.31(11) : 8628-8637, 2021-11 
Journal Title
Issue Date
Carcinoma, Hepatocellular* / diagnostic imaging ; Contrast Media ; Gadolinium DTPA ; Humans ; Liver Neoplasms* / diagnostic imaging ; Magnetic Resonance Imaging ; Retrospective Studies ; Sensitivity and Specificity
Capsules ; Carcinoma ; Gadoxetic acid ; Magnetic resonance imaging ; hepatocellular
Objectives: This study aimed to elucidate the relationship between gadoxetic acid-enhanced magnetic resonance imaging (MRI) features-enhancing capsule, corona enhancement or hypointense rim-observed in hepatocellular carcinomas (HCCs).

Methods: Of the HCCs surgically confirmed during a 5-year period (2013-2017), ≤ 3-cm lesions (n = 83) in 78 patients were evaluated. Presence of corona enhancement and enhancing capsule on multiphasic dynamic imaging and presence of hypointense rim on hepatobiliary phase imaging were determined retrospectively by two independent observers. The relationship among the three imaging features was statistically analysed and correlated with the presence of histologic fibrous capsules, tumour differentiation and gross morphologic type.

Results: There was substantial overall interobserver agreement in determining the presence of the three imaging features. Sixty (72.3%) lesions had histologic fibrous capsule positively correlated with all three imaging features (p < 0.05). Corona enhancement was the most common (66.3%) feature followed by enhancing capsule (61.4%) and hypointense rim (33.7%), and the correspondence rate of enhancing capsule to corona enhancement was 68.6% (p = 0.004). Corona enhancement was more frequently observed in moderately differentiated HCCs than other lesions (p = 0.012) and not dependent (p = 0.465) on the tumour size, while enhancing capsule was significantly dependent on tumour size, as indicated by univariate (p < 0.001) and multivariate analyses (odds ratio, 4.241; p = 0.002).

Conclusions: Among the capsular features, corona enhancement might closely relate to enhancing capsule in HCCs. Corona enhancement was not dependent on tumour size and had the highest incidence of appearance on gadoxetic acid-enhanced multiphasic dynamic MRI.

Key points: • Enhancing capsule has a limited role in the LI-RADS categorisation during gadoxetic acid-enhanced MRI. • Appearance of corona enhancement is closely related to enhancing capsule and is not dependent on size of HCCs. • Corona enhancement can substitute enhancing capsule in the diagnosis of HCCs during multiple arterial and portal venous phase gadoxetic acid-enhanced MRI.
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1. College of Medicine (의과대학) > Dept. of Radiology (영상의학교실) > 1. Journal Papers
Yonsei Authors
Kim, Joo Hee(김주희) ORCID logo https://orcid.org/0000-0001-5383-3602
Yu, Jeong Sik(유정식) ORCID logo https://orcid.org/0000-0002-8171-5838
Chung, Jae Joon(정재준) ORCID logo https://orcid.org/0000-0002-7447-1193
Cho, Eun Suk(조은석)
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