Hepatobiliary phase hypointensity on gadobenate dimeglumine-enhanced magnetic resonance imaging may improve the diagnosis of hepatocellular carcinoma

Yueming Li; Jianwei Chen; Shuping Weng; Chuan Yan; Rongping Ye; Yuemin Zhu; Liting Wen; Dairong Cao; Jinsheng Hong

doi:10.21037/atm.2020.02.38

Hepatobiliary phase hypointensity on gadobenate dimeglumine-enhanced magnetic resonance imaging may improve the diagnosis of hepatocellular carcinoma

Ann Transl Med. 2021 Jan;9(1):55. doi: 10.21037/atm.2020.02.38.

Authors

Yueming Li¹, Jianwei Chen^{1

2}, Shuping Weng³, Chuan Yan¹, Rongping Ye¹, Yuemin Zhu¹, Liting Wen¹, Dairong Cao¹, Jinsheng Hong⁴

Affiliations

¹ Department of Radiology, The First Affiliated Hospital of Fujian Medical University, Fuzhou, China.
² Department of Radiology, Fujian Provincial Cancer Hospital, Fuzhou, China.
³ Department of Radiology, Fujian Provincial Maternity and Child Health Hospital, Fuzhou, China.
⁴ Key Laboratory of Radiation Biology (Fujian Medical University), Fujian Province University; Department of Radiotherapy, The First Affiliated Hospital of Fujian Medical University, Fuzhou, China.

Abstract

Background: To determine the clinical value of hepatobiliary phase (HBP) hypointensity for noninvasive diagnosis of hepatocellular carcinoma (HCC).

Methods: A total of 246 high-risk patients with 263 selected nodules (126 HCCs, 137 non-HCCs) undergoing gadobenate dimeglumine (Gd-BOPTA)-enhanced magnetic resonance imaging (MRI) were included in the study. Imaging-based diagnoses of small (≤3 cm) and large (>3 cm) HCCs were made using the following 4 criteria: (I) non-rim arterial phase hyper-enhancement (APHE) plus hypointensity on the portal venous phase (PVP); (II) non-rim APHE plus hypointensity on the PVP and/or transitional phase (TP); (III) non-rim APHE plus hypointensity on the PVP and/or TP and/or HBP; (IV) criterion 3 plus non-LR-1/2/M. Based on typical imaging features, LR-1, LR-2, or LR-M (if definitely benign, probably benign, malignant but not HCC specific, respectively) were defined according to the Liver Imaging Reporting and Data System (LI-RADS). Sensitivities and specificities of imaging criteria were calculated and compared using McNemar's test.

Results: Among the diagnostic criteria for small HCCs, criterion 3 and 4, which included HBP hypointensity, showed significantly higher sensitivities (96.4% and 94.6%, respectively) than criterion 1 (58.9%, P<0.001 for both). Moreover, criterion 4, which included HBP hypointensity and ancillary features, showed significantly higher specificity (94.7%) than criterion 3 (66.7%, P<0.001) and comparable specificity to criterion 1 (97.4%, P=0.375), achieving the highest accuracies (94.7%). The diagnostic performance of criterion 4 for large HCCs was similar to that for small HCCs.

Conclusions: HBP hypointensity acquired from Gd-BOPTA-MRI can improve sensitivity and maintain high specificity in the diagnosis of both small and large HCCs after excluding benignities or non-HCC malignancies according to characteristic imaging features.

Keywords: Hepatocellular carcinoma (HCC); gadobenate dimeglumine; hepatobiliary phase (HBP); magnetic resonance imaging (MRI).