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

  • Hepatobiliary-Pancreas
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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.

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Abbreviations

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

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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.

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Authors and Affiliations

  1. Department of Radiology, Research Institute of Radiological Science, Yonsei University College of Medicine, Seoul, Korea

    Chansik An, Kyunghwa Han, Jin-Young Choi, Mi-Suk Park & Myeong-Jin Kim

  2. Department of Pathology, Brain Korea 21 PLUS Project for Medical Science, Integrated Genomic Research Center for Metabolic Regulation, Yonsei University College of Medicine, Seoul, Korea

    Hyungjin Rhee & Young-Nyun Park

  3. Severance Biomedical Science Institute, Yonsei University College of Medicine, Seoul, Korea

    Young-Nyun Park

  4. Department of Radiology, National Health Insurance Service Ilsan Hospital, Goyang, Korea

    Sumi Park

Authors
  1. Chansik An
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  2. Hyungjin Rhee
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  3. Kyunghwa Han
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  4. Jin-Young Choi
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  5. Young-Nyun Park
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  6. Mi-Suk Park
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  7. Myeong-Jin Kim
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  8. Sumi Park
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Corresponding author

Correspondence to Sumi Park.

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An, C., Rhee, H., Han, K. et al. Added value of smooth hypointense rim in the hepatobiliary phase of gadoxetic acid-enhanced MRI in identifying tumour capsule and diagnosing hepatocellular carcinoma. Eur Radiol 27, 2610–2618 (2017). https://doi.org/10.1007/s00330-016-4634-6

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  • DOI: https://doi.org/10.1007/s00330-016-4634-6

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