Adding ancillary features to enhancement patterns of hepatocellular carcinoma on gadoxetic acid-enhanced magnetic resonance imaging improves diagnostic performance
- Authors
- Min, Ji Hye; Kim, Young Kon; Sinn, Dong Hyun; Choi, Seo-Youn; Jeong, Woo Kyoung; Lee, Won Jae; Ha, Sang Yun; Ahn, Soohyun; Kim, Min-Ji
- Issue Date
- Sep-2018
- Publisher
- Springer New York
- Keywords
- Hepatocellular carcinoma; Magnetic resonance imaging; Diagnosis; Enhancement; Ancillary feature
- Citation
- Abdominal Radiology, v.43, no.9, pp 2309 - 2320
- Pages
- 12
- Journal Title
- Abdominal Radiology
- Volume
- 43
- Number
- 9
- Start Page
- 2309
- End Page
- 2320
- URI
- https://scholarworks.bwise.kr/sch/handle/2021.sw.sch/5678
- DOI
- 10.1007/s00261-018-1480-9
- ISSN
- 2366-004X
2366-0058
- Abstract
- To assess the added value of intratumoral ancillary features to conventional enhancement pattern-based diagnosis of hepatocellular carcinoma (HCC) on gadoxetic acid-enhanced magnetic resonance imaging (MRI). A total of 773 consecutive patients with surgically resected 773 primary hepatic tumors (699 HCCs, 63 intrahepatic cholangiocarcinomas, and 11 benign nodules) who underwent gadoxetic acid-enhanced MRI were retrospectively identified. Enhancement patterns and three ancillary features of capsule, septum, and T2 spotty hyperintensity were assessed by two radiologists. Performance of enhancement pattern-based diagnosis of HCC was compared to diagnosis of HCC based on enhancement pattern plus ancillary features. Enhancement patterns were positive (arterial diffuse hyperenhancement with washout) for 562 (72.7%) tumors, negative (no arterial hyperenhancement and no washout) for 75 (9.7%), and inconclusive (either no arterial hyperenhancement or no washout) for 136 (17.6%). Capsule was observed in 498 (64.4%) tumors, septum in 521 (67.3%), and T2 spotty hyperintensity in 107 (13.8%). The accuracy and sensitivity of HCC diagnosis was improved significantly after adding at least one ancillary feature compared with enhancement pattern-based diagnosis of HCCs (79.9% vs. 91.1% for accuracy, p < 0.0001 and 79.1% vs. 92.0% for sensitivity, p < 0.0001) with a minor tradeoff in specificity (87.8% vs. 82.4%, p = 0.125). Adding at least two ancillary features improved accuracy (88.1%, p < 0.0001) and sensitivity (88.1%, p < 0.0001) without changing specificity (87.8%, p = 1.0). Adding intratumoral ancillary features of capsule, septum and T2 spotty hyperintensity to conventional enhancement patterns on gadoxetic acid-enhanced MRI improved accuracy and sensitivity, while maintaining specificity for HCC diagnosis.
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