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Usefulness of combining gadolinium-ethoxybenzyl-diethylenetriamine pentaacetic acid-enhanced magnetic resonance imaging and contrast-enhanced ultrasound for diagnosing the macroscopic classification of small hepatocellular carcinoma

  • Hepatobiliary-Pancreas
  • Published:
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Abstract

Objective

Non-simple nodules in hepatocellular carcinoma (HCC) correlate with poor prognosis. Therefore, we examined the diagnostic ability of gadolinium-ethoxybenzyl-diethylenetriamine pentaacetic acid-enhanced magnetic resonance imaging (EOB-MRI) and contrast-enhanced ultrasound (CEUS) for diagnosing the macroscopic classification of small HCCs.

Methods

A total of 85 surgically resected nodules (≤30 mm) were analyzed.

HCCs were pathologically classified as simple nodular (SN) and non-SN. By evaluating hepatobiliary phase (HBP) of EOB-MRI and Kupffer phase of CEUS, the diagnostic abilities of both modalities to correctly distinguish between SN and non-SN were compared.

Results

Forty-six nodules were diagnosed as SN and the remaining 39 nodules as non-SN. The area under the ROC curve (AUROCs, 95 % confidence interval) for the diagnosis of non-SN were EOB-MRI, 0.786 (0.682–0.890): CEUS, 0.784 (0.679–0.889), in combination, 0.876 (0.792–0.959). The sensitivity, specificity, and accuracy were 64.1 %, 95.7 %, and 81.2 % in EOB-MRI, 56.4 %, 97.8 %, and 78.8 % in CEUS, and 84.6 %, 95.7 %, and 90.6 % in combination, respectively. High diagnostic ability was obtained when diagnosed in both modalities combined. The sensitivity was especially statistically significant compared to CEUS.

Conclusion

Combined diagnosis by EOB-MRI and CEUS can provide high-quality imaging assessment for determining non-SN in small HCCs.

Key Points

• Non-SN has a higher frequency of MVI and intrahepatic metastasis than SN.

• Macroscopic classification is useful to choose the treatment strategy for small HCCs.

• Diagnostic ability for macroscopic findings of EOB-MRI and CEUS were statistically equal.

• The diagnosis of macroscopic findings by individual modality has limitations.

• Combined diagnosis of EOB-MRI and CEUS provides high diagnostic ability.

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Abbreviations

AFP:

Alpha-fetoprotein

AP:

Arterial-phase

AUROC:

Area under the receiver operating characteristic curve

CECT:

Contrast-enhanced computed tomography

CEUS:

Contrast-enhanced ultrasound

CMN:

Confluent multinodular type

DCP:

Des-γ-carboxyprothrombin

EOB-MRI:

Gadolinium-ethoxybenzyl-diethylenetriamine pentaacetic acid-enhanced magnetic resonance imaging

Gd-EOB-DTPA:

Gadolinium-ethoxybenzyl-diethylenetriamine pentaacetic acid

HBP:

Hepatobiliary phase

HBV:

Hepatitis B virus

HCC:

Hepatocellular carcinoma

HCV:

Hepatitis C virus

ICG R15:

Indocyanine green retention rate at 15 minutes

IF:

Infiltrative type

MVI:

Microvascular invasion

NBNC:

Patients negative for both HBs antigen and HCV antibody

NPV:

Negative predictive value

PPV:

Positive predictive value

PVP:

Portal venous-phase

ROC:

Receiver operating characteristic

SN:

Simple nodular

SN-DM:

Simple nodular type with distinct margin

SN-EG:

Simple nodular type with extranodular growth

SN-IN:

Small nodular type with indistinct margin

US:

Ultrasound

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Acknowledgments

The scientific guarantor of this publication is Kazuaki Chayama, M.D., Ph.D. 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 MRI and CEUS contrast agents used in the present study were not provided/sponsored by the industry. The authors state that this work has not received any funding. No complex statistical methods were necessary for this paper. Institutional review board approval and written informed consent were not required because this study is a retrospective analysis of EOB-MRI and CEUS, obtained for clinical purposes. Methodology: retrospective, diagnostic or prognostic study / observational, performed at one institution#.

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Authors and Affiliations

  1. Department of Gastroenterology and Metabolism, Hiroshima University Hospital, 1-2-3 Kasumi, Minami-ku, Hiroshima, 734-8551, Japan

    Tomoki Kobayashi, Hiroshi Aikata, Masahiro Hatooka, Kei Morio, Reona Morio, Hiromi Kan, Hatsue Fujino, Takayuki Fukuhara, Keiichi Masaki, Atsushi Ohno, Noriaki Naeshiro, Takashi Nakahara, Yohji Honda, Eisuke Murakami, Tomokazu Kawaoka, Masataka Tsuge, Akira Hiramatsu, Michio Imamura, Yoshiiku Kawakami, Hideyuki Hyogo, Shoichi Takahashi & Kazuaki Chayama

  2. Liver Research Project Center, Hiroshima University, Hiroshima, Japan

    Kazuaki Chayama

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  1. Tomoki Kobayashi
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  2. Hiroshi Aikata
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Correspondence to Hiroshi Aikata.

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Kobayashi, T., Aikata, H., Hatooka, M. et al. Usefulness of combining gadolinium-ethoxybenzyl-diethylenetriamine pentaacetic acid-enhanced magnetic resonance imaging and contrast-enhanced ultrasound for diagnosing the macroscopic classification of small hepatocellular carcinoma. Eur Radiol 25, 3272–3281 (2015). https://doi.org/10.1007/s00330-015-3725-0

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