Added value of hepatobiliary phase gadoxetic acid-enhanced MRI for diagnosing hepatocellular carcinoma in high-risk patients

Table 1 Demographic characteristics of the study population (n = 100) n (%)

Variables	Results
Age (mean ± SD; range, yr)	59.5 ± 11.4 (range 27-89)
Sex (male:female)	71:29
Risk factors for HCC
Chronic HBV infection	20 (20)
Chronic HCV infection	2 (2)
Hepatitis B-related cirrhosis	45 (45)
Hepatitis C-related cirrhosis	16 (16)
Alcoholic cirrhosis	9 (9)
Nonalcoholic steatohepatitis	6 (6)
Only high serum AFP levels	2 (2)
Child-Pugh score
A	94 (94)
B	5 (5)
C	1 (1)
Alpha-fetoprotein (mean ± SD; range, ng/mL)	111.6 ± 935.1 (range 0.98-8973)
< 20	84 (84)
20-200	5 (5)
> 200	3 (3)
Total bilirubin (mean ± SD; range, mg/dL)	1.43 ± 2.5 (range 0.2-17.1)

HBV: Hepatitis B virus; HCV: Hepatitis C virus; HCC: Hepatocellular carcinoma; AFP: Alpha-fetoprotein.

Table 2 1.5-T and 3.0-T magnetic resonance pulse sequence parameters

Parameters	Double-echo T1-weighted gradient echo		Respiratory-triggered fast-spin T2-weighted		T1-weighted Gd-EOB-DTPA-enhanced
	1.5-T	3.0-T	1.5-T	3.0-T	1.5-T	3.0-T
Matrix	256 × 192	228 × 136	320 × 224	320 × 188	256 × 192	180 × 163
Section thickness (mm)	6-8	6	4	6	2-3	4
Intersection gap (mm)	2	2	1	2	-	-
TR (ms)	180-220	150-250	2000-4000	2500-3500	4.2	2.8
TE (ms)	2.3-4.6	1.15-2.3	60	65-85	2	1.4
Flip angle (degrees)	80	70	90	120	12	10
Reduction factor	2	2	2	2	2	2

Gd-EOB-DTPA: Gadolinium ethoxybenzyl diethylenetriaminepentaacetic.

Table 3 Diagnostic accuracy of diagnosing hepatocellular carcinoma using conventional dynamic magnetic resonance imaging or conventional dynamic magnetic resonance imaging with hepatobiliary phase images

	Conventional dynamic MRI	Conventional dynamic MRI+HBP	P value
All lesions	88.7%	95.5%	0.002
Lesions 1-2 cm	86.7%	94.0%	0.008
Lesions > 2 cm	94.4%	100%	0.145

MRI: Magnetic resonance imaging; HBP: Hepatobiliary phase.

Table 4 Sensitivity, specificity, and positive and negative predictive values for diagnosing hepatocellular carcinoma using conventional dynamic magnetic resonance imaging or conventional dynamic magnetic resonance imaging with hepatobiliary phase images

	Conventional dynamic MRI	95%CI	Conventional dynamic MRI+HBP	95%CI
Sensitivity	79.7%	67.2-89.0	93.2%	83.5-98.1
Specificity	97.8%	85.5-99.9	97.8%	88.5-99.9
Positive predictive value	97.9%	88.9-99.9	98.2%	90.4-100.0
Negative predictive value	78.9%	66.1-88.6	91.8%	80.4-97.7

MRI: Magnetic resonance imaging; HBP: Hepatobiliary phase.

Table 5 Sensitivity, specificity, and positive and negative predictive values for diagnosing hepatocellular carcinoma based on magnetic resonance imaging findings after excluding cysts and hemangiomas (n = 89)

MRI findings	Sensitivity (%)	Specificity (%)	Positive predictive value (%)	Negative predictive value (%)
Fat metamorphosis	16.9 (8.4-29.0)	93.3 (77.9-99.2)	83.3 (51.6-97.9)	36.4 (25.7-48.1)
Hyperintensity on T2-weighted images	66.1 (52.6-77.9)	93.3 (77.9-99.2)	95.1 (83.5-99.4)	58.3 (43.2-72.4)
Arterial enhancement	88.1 (77.1-95.1)	70.0 (50.6-85.3)	85.2 (73.8-93.0)	75.0 (55.1-89.3)
Arterial enhancement and washout on venous or equilibrium phase	79.7 (67.2-89.0)	96.7 (82.8-99.9)	97.9 (88.9-99.9)	70.7 (54.5-83.9)
Hypointensity on 20-min hepatobiliary phase	93.2 (83.5-98.1)	53.3 (34.3-71.7)	79.7 (68.3-88.4)	80.0 (56.3-94.3)
Arterial enhancement and no/partial uptake on 20-min hepatobiliary phase	83.1 (71.0-91.6)	93.3 (77.9-99.2)	96.1 (86.5-99.5)	73.7 (56.9-86.6)

MRI: Magnetic resonance imaging.

Table 6 Results of the univariate analysis of the magnetic resonance imaging findings for the diagnosis of hepatocellular carcinoma n (%)

MRI findings	All lesions (n = 105)			Lesions excluding cysts and hemangiomas (n = 89)
	HCC (n = 59)	Not HCC (n = 46)	P value	HCC (n = 59)	Not HCC (n = 30)	P value
Fat metamorphosis	10 (16.9)	2 (4.3)	0.061	10 (16.9)	2 (6.7)	0.190
Hyperintensity on T2-weighted images	39 (66.1)	18 (39.1)	0.007	39 (66.1)	2 (6.7)	< 0.001
Arterial enhancement	52 (88.1)	15 (32.6)	< 0.001	52 (88.1)	9 (30)	< 0.001
Arterial enhancement and washout on venous or equilibrium phase images	47 (79.7)	1 (2.2)	< 0.001	47 (79.7)	1 (3.3)	< 0.001
Hypointensity on 20-min hepatobiliary phase images	55 (93.2)	30 (65.2)	0.001	55 (93.2)	14 (46.7)	< 0.001
Arterial enhancement and no/partial uptake on 20-min hepatobiliary phase images	49 (83.1)	8 (17.4)	< 0.001	49 (83.1)	2 (6.7)	< 0.001

HCC: Hepatocellular carcinoma. MRI: Magnetic resonance imaging.

Table 7 Results of the multivariate analysis of the magnetic resonance imaging findings for diagnosing hepatocellular carcinoma

MRI findings	All lesions (n = 105)			Lesions excluding cysts and hemangiomas (n = 89)
	OR	95%CI	P value	OR	95%CI	P value
Hyperintensity on T2-weighted images	1.1	0.3-4.3	0.86	12.6	1.8-87.8	0.01
Arterial enhancement	1.8	0.4-7.0	0.42	3.5	0.5-22.8	0.18
Arterial enhancement and washout on venous or equilibrium phase images	102.0	10.3-1012.4	< 0.001	16.9	1.3-221.1	0.03
Hypointensity on 20-min hepatobiliary phase images	1.8	0.4-8.6	0.48	6.7	1.1-41.9	0.04

MRI: Magnetic resonance imaging.