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European Radiology

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01-04-2013 | Hepatobiliary-Pancreas

Added value of subtraction imaging in detecting arterial enhancement in small (<3 cm) hepatic nodules on dynamic contrast-enhanced MRI in patients at high risk of hepatocellular carcinoma

Authors: Chansik An, Mi-Suk Park, Dowhan Kim, Yeo-Eun Kim, Woo-Suk Chung, Hyungjin Rhee, Myeong-Jin Kim, Ki Whang Kim

Published in: European Radiology | Issue 4/2013

Abstract

Objectives

To determine the importance of arterial enhancement in diagnosing small (<3 cm) hepatocellular carcinomas (HCCs) and to evaluate the added value of dynamic subtraction magnetic resonance imaging (MRI) in detecting arterial enhancement in small (<3 cm) hepatic nodules in high-risk patients.

Methods

Eighty-six patients with 135 pathologically confirmed small (<3 cm) hepatic nodules (104 HCCs, 31 benign nodules) underwent MRI before curative surgery. Arterial enhancement was determined by three methods: (1) visual assessment of the arterial phase alone, (2) visual comparison of the arterial phase with the unenhanced phase and (3) additional review of subtraction images. The diagnostic performance of each method was calculated and compared using generalised estimating equations analysis.

Results

Arterial enhancement demonstrated high positive predictive value (PPV) (96.5–98.9 %) and specificity (90.3–96.8 %), but low negative predictive value (NPV) (54.6–62.5 %) and intermediate sensitivity (76–79.8 %) for diagnosing small HCCs. Diagnostic performance was highest for subtraction imaging. There were significant differences among the three methods in sensitivity (P = 0.04), accuracy (P = 0.044), PPV (P < 0.001) and NPV (P = 0.024), but not in specificity (P = 0.167).

Conclusion

The accurate detection of arterial enhancement in small hepatic nodules is important for diagnosing HCC and may be enhanced by subtraction imaging.

Key Points

• Arterial enhancement in small hepatic nodules indicates a high probability of malignancy

• Dynamic subtraction MRI can enable more accurate detection of arterial enhancement

• Subtraction imaging could lead to earlier diagnosis of hepatocellular carcinoma

• More timely care for patients might be provided

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Title: Added value of subtraction imaging in detecting arterial enhancement in small (<3 cm) hepatic nodules on dynamic contrast-enhanced MRI in patients at high risk of hepatocellular carcinoma
Authors: Chansik An
Mi-Suk Park
Dowhan Kim
Yeo-Eun Kim
Woo-Suk Chung
Hyungjin Rhee
Myeong-Jin Kim
Ki Whang Kim
Publication date: 01-04-2013
Publisher: Springer-Verlag
Published in: European Radiology / Issue 4/2013
Print ISSN: 0938-7994
Electronic ISSN: 1432-1084
DOI: https://doi.org/10.1007/s00330-012-2685-x

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Added value of subtraction imaging in detecting arterial enhancement in small (<3 cm) hepatic nodules on dynamic contrast-enhanced MRI in patients at high risk of hepatocellular carcinoma

Abstract

Objectives

Methods

Results

Conclusion

Key Points

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Objectives

Methods

Results

Conclusion

Key Points

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