European Radiology

, Volume 27, Issue 6, pp 2610–2618 | Cite as

Added value of smooth hypointense rim in the hepatobiliary phase of gadoxetic acid-enhanced MRI in identifying tumour capsule and diagnosing hepatocellular carcinoma

  • Chansik An
  • Hyungjin Rhee
  • Kyunghwa Han
  • Jin-Young Choi
  • Young-Nyun Park
  • Mi-Suk Park
  • Myeong-Jin Kim
  • Sumi Park
Hepatobiliary-Pancreas

Abstract

Objectives

To examine the added value of considering smooth hypointense rim in the hepatobiliary phase (HBP) of gadoxetic acid-enhanced MRI as capsule appearance for diagnosing tumour capsules and hepatocellular carcinoma (HCC).

Methods

A total of 377 hepatic lesions (330 HCCs, 35 non-HCC malignancies and 12 benign) were included from 345 patients who underwent resection after MRI between January 2008 and December 2011. Two radiologists assessed the presence or absence of conventional capsule appearance and smooth hypointense rim in the HBP, and categorized each hepatic lesion according to the Liver Imaging Reporting and Data System. Difference in diagnostic performance was evaluated using the generalized estimating equation method.

Results

For identifying capsule, the sensitivity and accuracy of HBP hypointense rim were significantly higher than those of conventional capsule appearance (81.5 % vs. 57.8 % and 76.1 % vs. 59.4 %, respectively; P < 0.001). For diagnosing HCC, the sensitivity and accuracy of LR-5 or LR-5 V were significantly higher when the HBP hypointense rim was also considered capsule appearance (83 % vs. 72.7 % and 84.1 % vs. 75.1 %, respectively; P < 0.001), with the same specificity (91.5 %).

Conclusions

Regarding smooth hypointense rim in the HBP as capsule appearance could improve the detection of tumour capsule and the diagnosis of HCC.

Key points

Identifying tumour capsule is important for diagnosis of hepatocellular carcinoma (HCC).

Gadoxetic acid-enhanced MRI provides hepatobiliary phase (HBP) images.

Smooth hypointense rim seen in HBP may represent tumour capsule.

Regarding smooth hypointense rim as capsule appearance may improve HCC diagnosis.

Keywords

Hepatocellular carcinoma Gadoxetic acid Magnetic resonance imaging Diagnosis Sensitivity and specificity 

Abbreviations and acronyms

AFP

alpha-fetoprotein

CC

cholangiocarcinoma

CI

confidence interval

CT

computed tomography

GEE

generalized estimating equation

HBP

hepatobiliary phase

HCC

hepatocellular carcinoma

LI-RADS

Liver Imaging Reporting and Data System

MRI

magnetic resonance imaging

OPTN

Organ Procurement and Transplantation Network

TE

echo time

TR

repetition time

Notes

Acknowledgments

The scientific guarantor of this publication is Myeong-Jin Kim. 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. The authors state that this work has not received any funding. One of the authors has significant statistical expertise. Institutional review board approval was obtained. Written informed consent was waived by the institutional review board. Some study subjects have been previously reported in An C et al. (2015) Single hepatocellular carcinoma: preoperative MR Imaging to predict early recurrence after curative resection. Radiology 276:433–443, where we developed and validated the prediction model for early recurrence of HCC after curative resection. This study is different from the previous study in that we focused on the diagnostic performance, not on the relationship between imaging findings and prognosis. Methodology: retrospective, cross-sectional study, performed at one institution.

References

  1. 1.
    Ishigami K, Yoshimitsu K, Nishihara Y et al (2009) Hepatocellular carcinoma with a pseudocapsule on gadolinium-enhanced MR images: correlation with histopathologic findings. Radiology 250:435–443CrossRefPubMedGoogle Scholar
  2. 2.
    Asayama Y, Nishie A, Ishigami K et al (2015) Distinguishing intrahepatic cholangiocarcinoma from poorly differentiated hepatocellular carcinoma using precontrast and gadoxetic acid-enhanced MRI. Diagn Interv Radiol 21:96–104CrossRefPubMedPubMedCentralGoogle Scholar
  3. 3.
    Kang Y, Lee JM, Kim SH, Han JK, Choi BI (2012) Intrahepatic mass-forming cholangiocarcinoma: enhancement patterns on gadoxetic acid-enhanced MR images. Radiology 264:751–760CrossRefPubMedGoogle Scholar
  4. 4.
    Khan AS, Hussain HK, Johnson TD, Weadock WJ, Pelletier SJ, Marrero JA (2010) Value of delayed hypointensity and delayed enhancing rim in magnetic resonance imaging diagnosis of small hepatocellular carcinoma in the cirrhotic liver. J Magn Reson Imaging 32:360–366CrossRefPubMedGoogle Scholar
  5. 5.
    Park HJ, Jang KM, Kang TW et al (2016) Identification of imaging predictors discriminating different primary liver tumours in patients with chronic liver disease on gadoxetic acid-enhanced MRI: a classification tree analysis. Eur Radiol 26:3102–3111CrossRefPubMedGoogle Scholar
  6. 6.
    Rimola J, Forner A, Tremosini S et al (2012) Non-invasive diagnosis of hepatocellular carcinoma ≤ 2 cm in cirrhosis. Diagnostic accuracy assessing fat, capsule and signal intensity at dynamic MRI. J Hepatol 56:1317–1323CrossRefPubMedGoogle Scholar
  7. 7.
    Suh YJ, Kim MJ, Choi JY, Park YN, Park MS, Kim KW (2011) Differentiation of hepatic hyperintense lesions seen on gadoxetic acid-enhanced hepatobiliary phase MRI. AJR Am J Roentgenol 197:W44–W52CrossRefPubMedGoogle Scholar
  8. 8.
    American College of Radiology. Liver Imaging Reporting and Data System. http://www.acr.org/Quality-Safety/Resources/LI-RADS. Accessed 12 May 2016
  9. 9.
    Wald C, Russo MW, Heimbach JK, Hussain HK, Pomfret EA, Bruix J (2013) New OPTN/UNOS policy for liver transplant allocation: standardization of liver imaging, diagnosis, classification, and reporting of hepatocellular carcinoma. Radiology 266:376–382CrossRefPubMedGoogle Scholar
  10. 10.
    Choi JY, Lee JM, Sirlin CB (2014) CT and MR imaging diagnosis and staging of hepatocellular carcinoma: part I. Development, growth, and spread: key pathologic and imaging aspects. Radiology 272:635–654CrossRefPubMedPubMedCentralGoogle Scholar
  11. 11.
    Cho ES, Choi JY (2015) MRI features of hepatocellular carcinoma related to biologic behavior. Korean J Radiol 16:449–464CrossRefPubMedPubMedCentralGoogle Scholar
  12. 12.
    Landis JR, Koch GG (1977) The measurement of observer agreement for categorical data. Biometrics 33:159–174CrossRefPubMedGoogle Scholar
  13. 13.
    Kim R, Lee JM, Shin CI et al (2016) Differentiation of intrahepatic mass-forming cholangiocarcinoma from hepatocellular carcinoma on gadoxetic acid-enhanced liver MR imaging. Eur Radiol 26:1808–1817CrossRefPubMedGoogle Scholar
  14. 14.
    Fowler KJ, Sheybani A, Parker RA et al (2013) Combined hepatocellular and cholangiocarcinoma (biphenotypic) tumors: imaging features and diagnostic accuracy of contrast-enhanced CT and MRI. AJR Am J Roentgenol 201:332–339CrossRefPubMedGoogle Scholar
  15. 15.
    Theise NNO, Park YN, Nakanuma Y (2010) Combined hepatocellular-cholangiocarcinoma. In: Bosman FT, Carneiro F, Hruban RH et al (eds) WHO classification of tumours of the digestive system. IARC, Lyon, pp 225–227Google Scholar
  16. 16.
    Sofue K, Sirlin CB, Allen BC, Nelson RC, Berg CL, Bashir MR (2016) How reader perception of capsule affects interpretation of washout in hypervascular liver nodules in patients at risk for hepatocellular carcinoma. J Magn Reson Imaging 43:1337–1345CrossRefPubMedGoogle Scholar
  17. 17.
    Luca A, Caruso S, Milazzo M et al (2010) Multidetector-row computed tomography (MDCT) for the diagnosis of hepatocellular carcinoma in cirrhotic candidates for liver transplantation: prevalence of radiological vascular patterns and histological correlation with liver explants. Eur Radiol 20:898–907CrossRefPubMedGoogle Scholar
  18. 18.
    Jang HJ, Kim TK, Khalili K et al (2013) Characterization of 1-to 2-cm liver nodules detected on HCC surveillance ultrasound according to the criteria of the American Association for the Study of Liver Disease: is quadriphasic CT necessary? AJR Am J Roentgenol 201:314–321CrossRefPubMedGoogle Scholar
  19. 19.
    Doo KW, Lee CH, Choi JW, Lee J, Kim KA, Park CM (2009) "Pseudo washout" sign in high-flow hepatic hemangioma on gadoxetic acid contrast-enhanced MRI mimicking hypervascular tumor. AJR Am J Roentgenol 193:W490–W496CrossRefPubMedGoogle Scholar
  20. 20.
    Joo I, Lee JM, Lee DH, Jeon JH, Han JK, Choi BI (2015) Noninvasive diagnosis of hepatocellular carcinoma on gadoxetic acid-enhanced MRI: can hypointensity on the hepatobiliary phase be used as an alternative to washout? Eur Radiol 25:2859–2868CrossRefPubMedGoogle Scholar

Copyright information

© European Society of Radiology 2016

Authors and Affiliations

  • Chansik An
    • 1
  • Hyungjin Rhee
    • 2
  • Kyunghwa Han
    • 1
  • Jin-Young Choi
    • 1
  • Young-Nyun Park
    • 2
    • 3
  • Mi-Suk Park
    • 1
  • Myeong-Jin Kim
    • 1
  • Sumi Park
    • 4
  1. 1.Department of Radiology, Research Institute of Radiological ScienceYonsei University College of MedicineSeoulKorea
  2. 2.Department of Pathology, Brain Korea 21 PLUS Project for Medical Science, Integrated Genomic Research Center for Metabolic RegulationYonsei University College of MedicineSeoulKorea
  3. 3.Severance Biomedical Science InstituteYonsei University College of MedicineSeoulKorea
  4. 4.Department of RadiologyNational Health Insurance Service Ilsan HospitalGoyangKorea

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