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



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).


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.


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 %).


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.


Hepatocellular carcinoma Gadoxetic acid Magnetic resonance imaging Diagnosis Sensitivity and specificity 

Abbreviations and acronyms






confidence interval


computed tomography


generalized estimating equation


hepatobiliary phase


hepatocellular carcinoma


Liver Imaging Reporting and Data System


magnetic resonance imaging


Organ Procurement and Transplantation Network


echo time


repetition time



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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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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