Bettina Maiwald MMed, Presenter: Nothing to Disclose

Donald Lobsien MD, Abstract Co-Author: Nothing to Disclose

Thomas Kurt Kahn MD, Abstract Co-Author: Nothing to Disclose

Patrick Stumpp MD, PhD, Abstract Co-Author: Research grant, Bayer AG

To compare ceMDCT with 3-T-MRI using Gd-EOB-DTPA in diagnosis of hepatocellular carcinoma (HCC) and additionally to evaluate the usefulness of DWI in this setting.

3-phase-liver-CT with Iopromide was performed in fifty patients (median age 60.6 years) with suspected or proven HCC. Within the next days (median time: 2.2d) they underwent a 3-Tesla-MRI-examination with Gd-EOB-DTPA and DWI at b-values of 0, 50 and 400 s/mm². Image analysis regarding number, size and detectability of liver lesions as well as image quality was accomplished by a radiologist. ADC-values were measured for each detected lesion. The histopathological report after resection or biopsy of a lesion served as the gold standard. In unresected lesions a surrogate of follow-up or complementary imaging techniques in combination with clinical and paraclinical parameters was used. Sensitivity, specifity, positive and negative predictive values were evaluated for each technique.

On a liver-lesion-per-patient-basis more neoplasms could be detected in MRI (2.7 versus 2.3 in CT). There was no additional lesion seen in DWI compared with the contrast-enhanced MRI sequences. With an average greatest diameter of 31 mm in CT and 29 mm in MRI the size of the lesions was larger and rated more heterogeneously in MRI (range between different sequences: 26 mm – 33 mm). ADC-measurements in 32 lesions showed extremely heterogenous values with a median of 1.2 ± 0.2 x 10-3 mm²/s (range from 0.07 ± 0.1 to 3.0 ± 0.1 x 10-3 mm²/s). Detectability of lesions was rated superior for CT (2.6 and 3.4 for MRI on a 5-point Likert-scale). Image quality was assessed similar for both methods (2.2 for CT vs. 2.3 for MRI on a 5-point Likert-scale). MRI showed superior sensitivity, positive and negative predictive values (sensitivity 92%, ppv 80% and npv 90% vs. sensitivity 85%, ppv 79% and npv 82% for CT). Specificity was 75% for both techniques.  

Gd-EOB-DTPA-enhanced MRI showed higher sensitivity, positive and negative predictive values for detection of HCC compared to ceCT and therefore it should be used as the first-line imaging method for this indication. DWI did not improve detection of HCC in our study.

Despite improved spatial resolution with modern multislice CT-scanners, contrast-enhanced MRI is still superior in the detection of HCC in the liver.

Maiwald, B, Lobsien, D, Kahn, T, Stumpp, P, Is 3 Tesla MRI Superior to 64-row CT in Diagnosis of Hepatocellular Carcinoma?.  Radiological Society of North America 2011 Scientific Assembly and Annual Meeting, November 26 - December 2, 2011 ,Chicago IL. http://archive.rsna.org/2011/11006658.html