| Purpose: This study aims to determine the clinical value of hepatobiliary phase(HBP)hypointensity for preoperative diagnosis of hepatocellular carcinoma(HCC).Methods:246 high-risk patients with 263 selected nodules(126 HCCs,137 non-HCCs)undergoing non-enhanced and gadobenatedimeglumine(Gd-BOPTA)enhanced MRI with hepatobiliary phase scan were included.Imaging-based diagnoses of small(≤3cm)and large(>3cm)HCCs were made respectively using the following four criteria: 1.non-rim arterial phase hyper-enhancement(APHE)plus hypointensity on the portal venous phase(PVP);2.non-rim APHE plus hypointensity on the PVP and/or delayed phase(DP);3.non-rim APHE plus hypointensity on the PVP and/or DP and/or HBP;4.criterion 3 plus non-LR-1/2/M.Based on typical imaging features,LR-1,LR-2 or LR-M(definitely benign,probably benign,probably or definitely malignant but not HCC specific)were defined according to LI-RADS.Sensitivities and specificities of imaging criteria were calculated and compared using Mc Nemar’s test.Results: Among 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).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 accuracy(94.7%).The diagnostic performance of criterion4 for large HCCs was similar to small HCCs.In large hepatic lesion group,criterion 4which included HBP hypointensityand non-LR-1/2/M showed significantly higher sensitivities(75.7%)than criterion 1(62.9%)(P = 0.004),and the specificity of criterion 4 was same as criterion 1(91.3%,P>0.999).Criterion 4 also showed the highest accuracy among these imaging criteria(79.6%).Conclusion:HBP hypointensity acquired from Gd-BOPTA-MRI can improve the sensitivity and maintain high specificity in the diagnosis of HCC. |
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