Ward J, Guthrie JA, Scott DJ, Atchley J, Wilson D, Davies MH, Wyatt JI, Robinson PJ. Hepatocellular carcinoma in the cirrhotic liver: double-contrast MR imaging for diagnosis.Radiology 2000 Jul;216(1):154-62
PURPOSE: To measure the
sensitivity and accuracy of double-contrast magnetic resonance
(MR) imaging for the diagnosis of hepatocellular carcinoma (HCC)
in the cirrhotic liver. MATERIALS AND METHODS: Twenty-seven patients
with MR features of dysplastic nodules and/or HCC were examined.
T2-weighted spin-echo and T1-weighted gradient-echo imaging was
performed before and after superparamagnetic iron oxide (SPIO)
administration and immediately followed by T1-weighted gradient-echo
imaging at 10, 40, and 120 seconds after bolus injection of a
gadolinium-based contrast material. Nonenhanced, nonenhanced plus
SPIO-enhanced, and nonenhanced plus SPIO-enhanced plus gadolinium-enhanced
images were reviewed. Alternative-free response receiver operating
characteristic (ROC) methodology was used to analyze the results,
which were correlated with histopathologic findings after transplantation
in 15 patients and at biopsy in 12. Lesions visualized with all
three techniques were characterized as a dysplastic nodule or
HCC, and ROC analysis was performed. RESULTS: For all observers,
SPIO-enhanced MR imaging (mean accuracy, 0.76) was more accurate
than nonenhanced MR imaging (mean accuracy, 0.64) (P <.04),
and double-contrast MR imaging (mean accuracy, 0.86) was more
accurate than SPIO-enhanced imaging (P <.05). Both types of
lesions were correctly characterized with all three techniques,
although observer confidence for lesion characterization was greatest
with double-contrast MR imaging. CONCLUSION: Double-contrast MR
imaging significantly improves the diagnosis of HCC compared with
SPIO-enhanced and nonenhanced imaging (P <.01).
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