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Added value of subtraction imaging in detecting arterial enhancement in small (<3 cm) hepatic nodules on dynamic contrast-enhanced MRI in patients at high risk of hepatocellular carcinoma

 Chansik An  ;  Mi-Suk Park  ;  Dowhan Kim  ;  Yeo-Eun Kim  ;  Woo-Suk Chung  ;  Hyungjin Rhee  ;  Myeong-Jin Kim  ;  Ki Whang Kim 
 EUROPEAN RADIOLOGY, Vol.23(4) : 924-930, 2013 
Journal Title
Issue Date
Adult ; Aged ; Carcinoma, Hepatocellular/pathology* ; Contrast Media ; Female ; Gadolinium DTPA* ; Hepatic Artery/pathology* ; Humans ; Image Enhancement/methods* ; Liver Neoplasms/pathology* ; Magnetic Resonance Imaging/methods* ; Male ; Middle Aged ; Reproducibility of Results ; Sensitivity and Specificity ; Subtraction Technique*
Diagnosis ; Hepatocellular carcinoma ; Magnetic resonance imaging ; Arterial enhancement ; Subtraction technique
OBJECTIVES: To determine the importance of arterial enhancement in diagnosing small (<3 cm) hepatocellular carcinomas (HCCs) and to evaluate the added value of dynamic subtraction magnetic resonance imaging (MRI) in detecting arterial enhancement in small (<3 cm) hepatic nodules in high-risk patients. METHODS: Eighty-six patients with 135 pathologically confirmed small (<3 cm) hepatic nodules (104 HCCs, 31 benign nodules) underwent MRI before curative surgery. Arterial enhancement was determined by three methods: (1) visual assessment of the arterial phase alone, (2) visual comparison of the arterial phase with the unenhanced phase and (3) additional review of subtraction images. The diagnostic performance of each method was calculated and compared using generalised estimating equations analysis. RESULTS: Arterial enhancement demonstrated high positive predictive value (PPV) (96.5-98.9 %) and specificity (90.3-96.8 %), but low negative predictive value (NPV) (54.6-62.5 %) and intermediate sensitivity (76-79.8 %) for diagnosing small HCCs. Diagnostic performance was highest for subtraction imaging. There were significant differences among the three methods in sensitivity (P = 0.04), accuracy (P = 0.044), PPV (P < 0.001) and NPV (P = 0.024), but not in specificity (P = 0.167). CONCLUSION: The accurate detection of arterial enhancement in small hepatic nodules is important for diagnosing HCC and may be enhanced by subtraction imaging.
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1. College of Medicine (의과대학) > Dept. of Pathology (병리학교실) > 1. Journal Papers
1. College of Medicine (의과대학) > Dept. of Radiology (영상의학교실) > 1. Journal Papers
Yonsei Authors
Kim, Ki Whang(김기황)
Kim, Myeong Jin(김명진) ORCID logo https://orcid.org/0000-0001-7949-5402
Kim, Yeo Eun(김여은)
Park, Mi-Suk(박미숙) ORCID logo https://orcid.org/0000-0001-5817-2444
An, Chansik(안찬식) ORCID logo https://orcid.org/0000-0002-0484-6658
Rhee, Hyungjin(이형진) ORCID logo https://orcid.org/0000-0001-7759-4458
Chung, Woo Seok(정우석)
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