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Small (≤3 cm) hepatocellular carcinoma in cirrhosis: the role of double contrast agents in MR imaging vs. multidetector-row CT

Ruolo della RM a doppio contrasto rispetto alla TC multidetettore nella diagnosi del piccolo epatocarcinoma (≤3 cm) su cirrosi

  • Abdominal Radiology/Radiologia Addominale
  • Published:
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Abstract

Purpose

We prospectively compared gadoliniumenhanced magnetic resonance imaging (dynamic MRI), superparamagnetic iron oxide (SPIO) (ferucarbotran) MRI and multidetector-row computed tomography (MDCT) and the combination of dynamic MRI plus MDCT vs. dynamic MRI plus SPIO-MRI (double-contrast MRI: DC-MRI) forthe detection of small (≤3 cm) hepatocellular carcinomas (HCCs).

Materials and Methods

Sixty-three patients with liver cirrhosis and suspicious nodules detected during ultrasound (US) surveillance underwent DC-MRI in the same imaging session and MDCT within 15 days. The final diagnosis was established at pathology on the explanted liver (n=10), resection (n=6) and biopsy (n=38) specimens or at 2-years’ follow-up (n=9).

Results

One hundred and twenty-three nodules were detected: 87 were confirmed HCCs in 54 patients. The accuracy of SPIO-MRI and dynamic MRI were similar, both being superior to MDCT. Dynamic MRI demonstrated the highest sensitivity (83.9%; p<0.001). especially for lesions <1 cm (90.6%) - coupled with a lower specificity (36.1%) than SPIO-MRI, particularly in subcentimeter lesions (28.6%). SPIO-MRI demonstrated the highest sensitivity for nodules >1 cm and the highest specificity (83.3%) superior to dynamic MRI (p<0.0001). In the per-lesion analysis, SPIO-MRI demonstrated a positive predictive value higher than dynamic MRI (p=0.0059) and than both the combinations dynamic MRI/MDCT and DC-MRI (p=0.0021 and p=0.0087, respectively). DC-MRI showed the highest sensitivity (97.7%) and accuracy (78.9%), detecting hypovascular and atypical HCCs >1 cm. Furthermore its per-patient negative predictive value was the highest (100%), and significantly higher than all the other methods.

Conclusions

DC-MRI is the most sensitive and accurate method and can be confidently used as a single-step procedure for the detection of small HCCs, with the exception of lesions <1 cm.

Riassunto

Obiettivo

Abbiamo condotto uno studio prospettico per la diagnosi del piccolo epatocarcinoma (HCC) (<3 cm) comparando la risonanza magnetica (RM) dinamica dopo iniezione di Gd-DTPA (RM-dinamica), RM dopo mezzo di contrasto superparamagnetico-Resovist (RM-SPIO) e tomografia computerizzata (TC) spirale multidetettore (TCMD) e le combinazioni di RM-dinamica/TCMD e di RM-dinamica/RM-SPIO (eseguendo una RM a doppio contrasto, RM-DC).

Materiali e metodi

Sessantatre pazienti cirrotici con noduli sospetti individuati durante la sorveglianza ecografica (US) hanno eseguito una RM-dinamica ed una RM-SPIO nella stessa seduta ed una TCMD entro 15 giorni. La diagnosi definitiva viene fornita dal reperto anatomo-patologico — su fegato espiantato (n=10), resezione (n=6) e biopsia (n=38) — o da follow-up di 2 anni (n=9).

Risultati

Sono stati individuati 123 noduli, di cui 87 HCC in 54 pazienti. RM-SPIO e RM-dinamica hanno mostrato accuratezza simile, superiore alla TCMD. La RMdinamica ha dimostrato la maggiore sensibilità (83,9%; p<0,001), specie per lesioni<1 cm (90,6%), associata a minore specificità (36,1%) rispetto alla RM-SPIO, specie in lesioni subcentimetriche (28,6%). La RM-SPIO ha dimostrato la massima sensibilità per i noduli>1 cm e una specificità (83,3%) più elevata della RM-dinamica (p<0,0001). Nell’analisi per lesione la RM-SPIO ha dimostrato un valore predittivo positivo superiore alla RM-dinamica (p=0,0059) ed alla combinazione RMdinamica/TCMD e RM-DC (rispettivamente p=0,0021 e p=0,0087). La RM-DC ha dimostrato la più alta sensibilità (97,7%) ed accuratezza (78,9%), individuando gli HCC>1 cm ipovascolari ed atipici; inoltre il suo valore predittivo negativo per paziente è massimale (100%) e significativamente superiore a tutte le altre metodiche.

Conclusioni

La RM-DC si è rivelata la metodica più sensibile e accurata e può essere adottata con sicurezza come singola metodica per l’individuazione dei piccoli HCC, pur presentando alcuni limiti nelle lesioni<1 cm.

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Authors and Affiliations

  1. Radiologia Malpighi, Azienda Ospedaliero-Universitaria di Bologna, Policlinico S. Orsola-Malpighi, Università di Bologna, Via Albertoni 15, 40138, Bologna, Italy

    R. Golfieri, E. Marini, A. Bazzocchi & F. Fusco

  2. Dipartimento di Malattie Apparato digerente e Medicina Interna, Azienda Ospedaliero-Universitaria di Bologna, Policlinico S. Orsola-Malpighi, Università di Bologna, Via Albertoni 15, 40138, Bologna, Italy

    F. Trevisani, C. Sama, G. Mazzella, F. Piscaglia & L. Bolondi

  3. Dipartimento di Statistica “G. Parenti”, Università di Firenze, Firenze, Italy

    S. Cavuto

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  1. R. Golfieri
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  10. L. Bolondi
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Golfieri, R., Marini, E., Bazzocchi, A. et al. Small (≤3 cm) hepatocellular carcinoma in cirrhosis: the role of double contrast agents in MR imaging vs. multidetector-row CT. Radiol med 114, 1239–1266 (2009). https://doi.org/10.1007/s11547-009-0439-x

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