Diagnosing HCC with conventional and late portal venous phase MRI: intraindividual comparison of MRI with extracellular contrast agent

Abstract

Objectives To evaluate the diagnostic performance of MRI with gadoxetate disodium (EOB-MRI) using conventional portal venous phase (CPVP) and late portal venous phase (LPVP) in the noninvasive diagnosis of hepatocellular carcinoma (HCC), with intraindividual comparison of MRI with extracellular contrast agent (ECA-MRI).Materials and methods This retrospective study included 107 prospectively enrolled at-risk patients (mean age, 59.4 years; 89 men) with 143 lesions (118 HCCs) who underwent both ECA-MRI and EOB-MRI using CPVP and LPVP. Two radiologists assessed all lesions using LI-RADS v2018. The per-lesion diagnostic performance was compared using generalized estimating equations.Results In HCCs, nonperipheral washout appearance was less frequent on EOB-MRI using CPVP than on ECA-MRI (R1: 69.5 vs. 79.7%, p = 0.02; R2: 66.9 vs. 76.3%, p = 0.02), but more frequent on EOB-MRI using LPVP than on ECA-MRI (R1: 94.1 vs. 79.7%, p < 0.001; R2: 92.4 vs. 76.3%, p < 0.001). For LR-5, EOB-MRI using LPVP showed significantly higher sensitivity for diagnosing HCC than ECA-MRI (R1, 80.5 vs. 72.0%, p = 0.03; R2: 79.7 vs. 71.2%, p = 0.01), while EOB-MRI using CPVP showed significantly lower sensitivity than ECA-MRI (R1: 64.4 vs. 72.0%, p = 0.03; R2: 64.4 vs. 71.2%, p = 0.03). The specificity of EOB-MRI using LPVP (both Readers: 88.0%) did not differ significantly from that of ECA-MRI (both Readers: 92.0%, p = 0.31) or EOB-MRI using CPVP (both Readers: 92.0%, p = 0.31).Conclusions EOB-MRI using LPVP demonstrated higher sensitivity for HCC diagnosis than ECA-MRI and EOB-MRI using CPVP, while maintaining comparable specificity.Key PointsQuestionMRI with gadoxetate disodium (EOB-MRI) using the late portal venous phase (LPVP) for HCC diagnosis has not been directly compared with MRI with extracellular contrast agent (ECA-MRI).FindingsEOB-MRI using LPVP improved the sensitivity of HCC diagnoses compared with ECA-MRI and EOB-MRI using conventional portal venous phase, without compromising specificity.Clinical relevanceEOB-MRI using LPVP may be a suitable option for HCC diagnosis, demonstrating higher sensitivity than ECA-MRI without compromising specificity.Key PointsQuestionMRI with gadoxetate disodium (EOB-MRI) using the late portal venous phase (LPVP) for HCC diagnosis has not been directly compared with MRI with extracellular contrast agent (ECA-MRI).FindingsEOB-MRI using LPVP improved the sensitivity of HCC diagnoses compared with ECA-MRI and EOB-MRI using conventional portal venous phase, without compromising specificity.Clinical relevanceEOB-MRI using LPVP may be a suitable option for HCC diagnosis, demonstrating higher sensitivity than ECA-MRI without compromising specificity.Key PointsQuestionMRI with gadoxetate disodium (EOB-MRI) using the late portal venous phase (LPVP) for HCC diagnosis has not been directly compared with MRI with extracellular contrast agent (ECA-MRI).FindingsEOB-MRI using LPVP improved the sensitivity of HCC diagnoses compared with ECA-MRI and EOB-MRI using conventional portal venous phase, without compromising specificity.Clinical relevanceEOB-MRI using LPVP may be a suitable option for HCC diagnosis, demonstrating higher sensitivity than ECA-MRI without compromising specificity.