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Gadoxetic acid-enhanced magnetic resonance improved diagnosis of HCC in small nodules

The use of gadoxetic acid as a contrast agent for magnetic resonance can improve the sensitivity of hepatocellular carcinoma diagnosis in patients with cirrhosis, according to recent results.

Researchers performed gadoxetic acid-enhanced magnetic resonance (MR) on 48 small liver nodules (10 mm to 30 mm) in a cohort of 33 cirrhotic patients. Participants also underwent contrast-enhanced ultrasound (CEUS) and helical-CT.

Nodules were classified as hepatocellular carcinoma (HCC) in 79% of cases. Of these diagnoses, 63% were based on noninvasive criteria, 11 were diagnosed at histology, and three were determined during follow-up.

MR detected the typical vascular pattern of arterial hypervascularization and venous/delayed washout in 79% of cancerous nodules, while rates by CT and CEUS were 58% and 45%, respectively. MR was significantly more sensitive to this pattern than CEUS (P=.004 for HCC nodules; P=.008 for 1 cm to 2 cm nodules). MR also was more sensitive to the pattern in nodules larger than 2 cm; differences between imaging techniques, however, were not statistically significant.

Hypointensity occurred in all HCC nodules, plus three nonmalignant nodules, during the hepatobiliary phase of MR. Overall accuracy in this phase was calculated at a sensitivity of 100%, specificity of 70% and positive and negative predictive values of 93% and 100%, respectively.

Investigators also noted hypointensity during the hepatobiliary phase, as well as washout during the portal/venous phase, in eight cancerous nodules during MRI. Seven nodules indicated none of the typical vascular features at any imaging modality.

“Early diagnosis of HCC is the most important step capable of positively impacting the prognosis of the disease,” the researchers wrote. “The opportunity of achieving it by means of noninvasive tools remains a difficult challenge. … Our study showed that [gadoxetic acid-enhanced] MR might significantly impact the surveillance strategy of cirrhotic patients and emphasized the importance of the combination of the vascular and the hepatobiliary phases in the characterization of small nodules.”

Disclosure: See the study for a full list of relevant disclosures.