Hepatocellular carcinoma detection in liver cirrhosis: diagnostic performance of contrast-enhanced CT vs. MRI with extracellular contrast vs. gadoxetic acid

  • Sahar Semaan
  • Naik Vietti Violi
  • Sara Lewis
  • Manjil Chatterji
  • Christopher Song
  • Cecilia Besa
  • James S. Babb
  • M. Isabel Fiel
  • Myron Schwartz
  • Swan Thung
  • Claude B. Sirlin
  • Bachir TaouliEmail author



To evaluate the diagnostic performance of contrast-enhanced CT vs. MRI with extracellular contrast agents (EC-MRI) vs. MRI with gadoxetic acid (EOB-MRI) for HCC detection in patients with liver cirrhosis using liver explant as the reference. The additional value of hepatobiliary phase (HBP) post Gadoxetic acid was also assessed.


Two-hundred seventy-seven consecutive patients who underwent liver transplantation over a 9 year period and imaging within 90 days of were retrospectively included. Imaging consisted in CT (n = 100), EC-MRI (n = 77) and EOB-MRI (n = 100), the latter subdivided into dynamic EOB-MRI and full EOB-MRI (dynamic+HBP). Three radiologists retrospectively categorized lesions ≥ 1 cm using the LI-RADSv2017 algorithm. Dynamic EOB-MRI was re-evaluated with the addition of HBP. Results were correlated with explant pathology.


Pathology demonstrated 265 HCCs (mean size 2.1 ± 1.4 cm) in 177 patients. Per-patient sensitivities were 86.3% for CT, 89.5% for EC-MRI, 92.8% for dynamic EOB-MRI and 95.2% for full EOB-MRI (pooled reader data), with a significant difference between CT and dynamic/full EOB-MRI (p = 0.032/0.002), and between EC-MRI and full EOB-MRI (p = 0.047). Per-lesion sensitivities for CT, EC-MRI, dynamic EOB-MRI and full EOB-MRI were 59.5%,78.5%,69.7% and 76.8%, respectively, with a significant difference between MRI groups and CT (p-range:0.001–0.04), and no difference between EC-MRI and dynamic EOB-MRI (p = 0.949). For HCCs 1–1.9 cm, sensitivities were 34.4%, 64.6%, 57.3% and 67.3%, respectively, with all MRI groups significantly superior to CT (p ≤ 0.01) and full EOB-MRI superior to dynamic EOB-MRI (p = 0.002).


EOB-MRI outperforms CT and EC-MRI for per-patient HCC detection sensitivity, and is equivalent to EC-MRI for per-lesion sensitivity. MRI methods outperform CT for detection of HCCs 1–1.9 cm.

Key points

• MRI is superior to CT for HCC detection in patients with liver cirrhosis.

• EOB-MRI outperforms CT and MRI using extracellular contrast agents (EC-MRI) for per-patient HCC detection sensitivity, and is equivalent to EC-MRI for per-lesion sensitivity.

• The addition of hepatobiliary phase images improves HCC detection when using gadoxetic acid.


Liver neoplasms Magnetic resonance imaging Contrast media Tomography, spiral computed 



Computed tomography


Diffusion-weighted imaging


Extracellular gadolinium based contrast-enhanced MRI


Gadoxetic acid-enhanced MRI


False positive


Gadolinium based contrast agents


Hepatobiliary phase


Liver imaging reporting and data system


Negative predictive value


Positive predictive value


True negative


True positive


United network for organ sharing


Funding information

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

Compliance with ethical standards


The scientific guarantor of this publication is Bachir Taouli.

Conflict of interest

The authors of this manuscript declare relationships with the following companies:

Bachir Taouli: Grant, Bayer Healthcare.

The other 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 (JS Babb) has significant statistical expertise.

Informed consent

Written informed consent was waived by the Institutional Review Board.

Ethical approval

Institutional Review Board approval was obtained.


• retrospective.

• case-control study.

• performed at one institution.

Supplementary material

330_2019_6458_MOESM1_ESM.docx (20 kb)
ESM 1 (DOCX 19 kb)


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Copyright information

© European Society of Radiology 2019

Authors and Affiliations

  • Sahar Semaan
    • 1
    • 2
  • Naik Vietti Violi
    • 2
    • 3
  • Sara Lewis
    • 1
    • 2
  • Manjil Chatterji
    • 1
  • Christopher Song
    • 1
  • Cecilia Besa
    • 2
    • 4
  • James S. Babb
    • 5
  • M. Isabel Fiel
    • 6
  • Myron Schwartz
    • 7
  • Swan Thung
    • 6
  • Claude B. Sirlin
    • 8
  • Bachir Taouli
    • 1
    • 2
    Email author
  1. 1.Department of Radiology, Body MRIIcahn School of Medicine at Mount SinaiNew YorkUSA
  2. 2.Translational and Molecular Imaging InstituteIcahn School of Medicine at Mount SinaiNew YorkUSA
  3. 3.Department of RadiologyLausanne University HospitalLausanneSwitzerland
  4. 4.Department of Radiology, School of MedicinePontificia Universidad Católica de ChileSantiagoChile
  5. 5.Department of RadiologyNew York University Langone Medical CenterNew YorkUSA
  6. 6.Department of PathologyIcahn School of Medicine at Mount SinaiNew YorkUSA
  7. 7.Recanati/Miller Transplantation InstituteIcahn School of Medicine at Mount SinaiNew YorkUSA
  8. 8.Liver Imaging Group, Department of RadiologyUC San Diego Medical CenterSan DiegoUSA

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