MRI for characterization of benign hepatocellular tumors on hepatobiliary phase: the added value of in-phase imaging and lesion-to-liver visual signal intensity ratio

  • P. LebertEmail author
  • M. Adens-Fauquembergue
  • M. Azahaf
  • V. Gnemmi
  • H. Behal
  • A. Luciani
  • O. Ernst



To evaluate the lesion-to-liver visual signal intensity ratio (SIR) before and at the hepatobiliary phase MRI (HBP-MRI) after gadobenate dimeglumine (Gd-BOPTA) injection, using several T1-weighted images (T1-WI), for the characterization of benign hepatocellular lesions.


Patients with histologically proven focal nodular hyperplasia (FNH) and hepatocellular adenoma (HCA), who underwent Gd-BOPTA-enhanced HBP-MRI from 2009 to 2017, were retrospectively identified. The lesion-to-liver SIR was visually assessed by two radiologists on HBP (post-HBP analysis) and compared with that of unenhanced sequences (pre/post-HBP analysis) on T1-WI in-phase (T1-IP), out-of-phase (T1-OP), and fat suppression (T1-FS). Lesions were classified as hyper-, iso-, or hypointense on post-HBP, and as decreasing, stable, or increasing SIR on pre/post-HBP analyses. The performance of the different T1-WI sequences for the diagnostic of FNH was evaluated on post-HBP analysis.


Twenty-nine FNHs and 33 HCAs were analyzed. On post-HBP analysis, FNHs appeared hyper-/isointense in 89.7% of all T1-WI. HCAs appeared hypointense in 93.9%, 63.6%, and 69.7% of T1-IP, T1-OP, and T1-FS, respectively. FNHs exhibited an increasing SIR in 55.2–58.6%, a stable SIR in 44.8–58.6%, and a decreasing SIR in 0%, whereas HCAs exhibited a decreasing SIR in 66.7–93.9%, a stable SIR in 6.1–33.3%, and an increasing SIR in 0% (p < 0.0001). The specificity of T1-IP was significantly higher than that of T1-OP (p = 0.015) and T1-FS (p = 0.042).


T1-IP is the most reliable sequence due to misleading tumor/liver signal ratio in the case of fatty liver when using T1-FS or T1-OP. The pre/post-HBP lesion-to-liver SIR is accurate to classify benign hepatocellular lesions and contributes to avoid biopsy.

Key Points

•The T1-weighted images in-phase should be systematically included in the HBP-MRI protocol, as it is the most reliable sequence especially in the case of fatty liver.

•The comparison between lesion-to-liver signal intensity ratios on unenhanced and at the hepatobiliary phase sequences is useful to classify benign hepatocellular lesions in three categories without misclassification: FNH (increasing signal intensity ratio), HCA (decreasing signal intensity ration), and indeterminate lesions (stable signal intensity ratio).


Focal nodular hyperplasia Gadobenate dimeglumine Hepatocellular adenoma Liver Magnetic resonance imaging 



Focal nodular hyperplasia


Gadobenate dimeglumine


Gadoxetic acid


Gradient-recalled echo


Hepatocellular adenoma


Hepatobiliary phase


Hepatobiliary-specific contrast agents


Organic anionic transport protein


Signal intensity ratio


T1-weighted images with fat suppression


T1-weighted images in-phase


T1-weighted image out-of-phase


T1-WI high-resolution isotropic volume examination


Volumetric interpolated breath-hold examination


Weighted images



The authors state that this work has not received any funding.

Compliance with ethical standards


The scientific guarantor of this publication is O. Ernst.

Conflict of interest

The authors of this manuscript declare no relationships with any companies, whose products or services may be related to the subject matter of the article.

Statistics and biometry

One of the authors has significant statistical expertise (H. Behal).

Informed consent

Written informed consent was waived by the Institutional Review Board.

Ethical approval

Institutional Review Board approval was obtained.

Study subjects or cohorts overlap

Some study subjects or cohorts have been previously reported in: Roux et al (2015) Differentiation of focal nodular hyperplasia from hepatocellular adenoma: Role of the quantitative analysis of gadobenate dimeglumine-enhanced hepatobiliary phase MRI. J Magn Reson Imaging JMRI 42(5):1249–58.


• Retrospective, diagnostic or prognostic study, performed at two institutions


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Copyright information

© European Society of Radiology 2019

Authors and Affiliations

  1. 1.Department of Gastrointestinal ImagingLille University HospitalLille CedexFrance
  2. 2.Department of PathologyLille University HospitalLille CedexFrance
  3. 3.Department of BiostatisticsLille University HospitalLille CedexFrance
  4. 4.Groupe Henri Mondor Albert Chenevier, Imagerie Medicale, AP-HPCreteilFrance

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