Differentiation of hypervascular primary hepatic tumors showing hepatobiliary hypointensity on gadoxetic acid-enhanced magnetic resonance imaging
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To determine the imaging features that help differentiate hypervascular primary hepatic tumors showing hepatobiliary hypointensity on gadoxetic acid MRI.
This study comprised 148 patients with pathologically proven hypervascular hepatic tumors who underwent gadoxetic acid MRI. Tumors included 23 atypical focal nodular hyperplasias (FNHs), 11 hepatocellular adenomas (HCAs), 15 neuroendocrine tumors (NETs), 25 intrahepatic cholangiocarcinomas (ICCs), and 74 hepatocellular carcinomas (HCCs). MRIs were analyzed for morphologic features, signal intensity, and enhancement pattern of the tumors to determine the differential features using multivariate logistic regression analysis. We evaluated the diagnostic performance of the MRI features for differentiating the five tumor types upon review by two observers.
Multivariate analysis revealed that reverse target sign on hepatobiliary phase in FNHs (p = 0.009), iso or hyperintensity on ADC map in FNHs and HCAs (p = 0.009, < 0.001, respectively), central hypointensity on arterial phase in NETs (p = 0.001), hepatobiliary target sign in ICCs (p = 0.002), the presence of septum and capsule in HCCs (all p < 0.001) were significant independent features of each tumor group over other tumor groups. Diagnostic accuracy for both observers was 98–98.6% for FNHs, 96.6–98% for HCAs, 97.3–98.6% for NETs, 90.5–94.6% for ICCs, and 85.8–93.2% for HCCs.
Ancillary MRI features established in our study can be helpful in the differentiation of hypervascular and hepatobiliary hypointense primary hepatic tumors on gadoxetic acid MRI.
KeywordsGadoxetic acid MRI Hypervascular hepatic tumor Ancillary feature
Compliance with ethical standards
Conflict of interest
The authors declare that they have no conflict of interest.
- 1.Neri E, Bali MA, Ba-Ssalamah A, Boraschi P, Brancatelli G, Alves FC, Grazioli L, Helmberger T, Lee JM, Manfredi R, Marti-Bonmati L, Matos C, Merkle EM, Op De Beeck B, Schima W, Skehan S, Vilgrain V, Zech C, Bartolozzi C (2016) ESGAR consensus statement on liver MR imaging and clinical use of liver-specific contrast agents. Eur Radiol 26:921-931. https://doi.org/10.1007/s00330-015-3900-3 CrossRefGoogle Scholar
- 4.Hamm B, Staks T, Muhler A, Bollow M, Taupitz M, Frenzel T, Wolf KJ, Weinmann HJ, Lange L (1995) Phase I clinical evaluation of Gd-EOB-DTPA as a hepatobiliary MR contrast agent: safety, pharmacokinetics, and MR imaging. Radiology 195:785-792. https://doi.org/10.1148/radiology.195.3.7754011 CrossRefGoogle Scholar
- 8.Motosugi U, Ichikawa T, Sou H, Sano K, Tominaga L, Muhi A, Araki T (2010) Distinguishing hypervascular pseudolesions of the liver from hypervascular hepatocellular carcinomas with gadoxetic acid-enhanced MR imaging. Radiology 256:151-158. https://doi.org/10.1148/radiol.10091885 CrossRefGoogle Scholar
- 12.Rimola J, Forner A, Reig M, Vilana R, de Lope CR, Ayuso C, Bruix J (2009) Cholangiocarcinoma in cirrhosis: absence of contrast washout in delayed phases by magnetic resonance imaging avoids misdiagnosis of hepatocellular carcinoma. Hepatology 50:791-798. https://doi.org/10.1002/hep.23071 CrossRefGoogle Scholar
- 16.Fujiwara H, Sekine S, Onaya H, Shimada K, Mikata R, Arai Y (2011) Ring-like enhancement of focal nodular hyperplasia with hepatobiliary-phase Gd-EOB-DTPA-enhanced magnetic resonance imaging: radiological-pathological correlation. Jpn J Radiol 29:739-743. https://doi.org/10.1007/s11604-011-0624-4 CrossRefGoogle Scholar
- 18.Grazioli L, Bondioni MP, Haradome H, Motosugi U, Tinti R, Frittoli B, Gambarini S, Donato F, Colagrande S (2012) Hepatocellular adenoma and focal nodular hyperplasia: value of gadoxetic acid-enhanced MR imaging in differential diagnosis. Radiology 262:520-529. https://doi.org/10.1148/radiol.11101742 CrossRefGoogle Scholar
- 21.Ishigami K, Yoshimitsu K, Nishihara Y, Irie H, Asayama Y, Tajima T, Nishie A, Hirakawa M, Ushijima Y, Okamoto D, Taketomi A, Honda H (2009) Hepatocellular carcinoma with a pseudocapsule on gadolinium-enhanced MR images: correlation with histopathologic findings. Radiology 250:435-443. https://doi.org/10.1148/radiol.2501071702 CrossRefGoogle Scholar
- 31.Zech CJ, Grazioli L, Breuer J, Reiser MF, Schoenberg SO (2008) Diagnostic performance and description of morphological features of focal nodular hyperplasia in Gd-EOB-DTPA-enhanced liver magnetic resonance imaging: results of a multicenter trial. Invest Radiol 43:504-511. https://doi.org/10.1097/rli.0b013e3181705cd1 CrossRefGoogle Scholar
- 32.Joo I, Lee JM, Lee SM, Lee JS, Park JY, Han JK (2016) Diagnostic accuracy of liver imaging reporting and data system (LI-RADS) v2014 for intrahepatic mass-forming cholangiocarcinomas in patients with chronic liver disease on gadoxetic acid-enhanced MRI. J Magn Reson Imaging 44:1330-1338. https://doi.org/10.1002/jmri.25287 CrossRefGoogle Scholar