Capsule, septum, and T2 hyperintense foci for differentiation between large hepatocellular carcinoma (≥5 cm) and intrahepatic cholangiocarcinoma on gadoxetic acid MRI

• DOI: 10.1007/s00330-017-4846-4
• Publication Date: 2017-05-12T13:06:47Z
• Authors: Jiyoung Hwang; Young Kon Kim; Ji Hye Min; Seo-Youn Choi; Woo Kyung Jeong; Seong Sook Hong; Hyun-joo Kim; Soohyun Ahn; Hyeon Seon Ahn
• Keywords: Gadolinium DTPA; Male; Carcinoma, Hepatocellular; Liver Neoplasms; Contrast Media; Middle Aged; Magnetic Resonance Imaging; Cholangiocarcinoma; 03 medical and health sciences; Bile Ducts, Intrahepatic; 0302 clinical medicine; Liver; Humans; Female; Neoplasm Staging; Retrospective Studies

To determine the added value of capsule, septum, and T2 hyperintense foci for differentiating large hepatocellular carcinoma (HCC; ≥ 5 cm) from intrahepatic cholangiocarcinoma (ICC) using gadoxetic acid MRI.The study included 116 patients (94 men, 22 women; mean age, 56.8 years) with surgically confirmed HCCs (n = 87, 5.0-18.0 cm) or ICCs (n = 29, 5.0-14.0 cm) who underwent gadoxetic acid MRI. Three observers independently reviewed MRIs in two sessions, examining enhancement patterns only and then adding capsule, septum, and T2 hyperintense foci. Reviewers used a five-point scale to score accuracy, sensitivity, and specificity.A significant increase was observed in accuracy when ancillary features (96.1-98.3%) were added compared to enhancement pattern only (83.6-88.4%; p ≤ 0.02). Sensitivity was significantly increased with combined reading (97.1-98.3%) compared to enhancement features only (81.6-88.5%; p ≤ 0.006) for two observers, with no difference in specificity (84.5-89.7% vs. 86.2-98.3%; p > 0.05). We found substantial to excellent interobserver agreement for ancillary features (0.598-0.976).Adding capsule, septum, and T2 hyperintense foci to enhancement patterns for gadoxetic acid MRI increased diagnostic performance for characterizing large HCC by differentiating it from ICC.• Capsule, septum, and T2 hyperintense foci were useful for characterizing large HCC. • Adding ancillary features to enhancement pattern increased accuracy for diagnosing large HCC. • Interobserver agreement was substantial to excellent for ancillary features.