MRI versus 64-row MDCT for diagnosis of hepatocellular carcinoma

Abstract

Aim: To compare the diagnostic capability of multidetector computed tomography (MDCT) and magnetic resonance imaging (MRI) for the detection of hepatocellular carcinoma (HCC) tumour nodules and their effect on patient management.

Methods: A total of 28 patients (25 male, 3 female, mean age 67 +/- 10.8 years) with biopsy-proven HCC were investigated with 64-row MDCT (slice 3 mm native, arterial and portal-venous phase, 120 mL Iomeprol, 4 mL/s, delay by bolus trigger) and MRI (T1fs fl2d TE/TR 2.72/129 ms, T2tse TE/TR 102/4000 ms, 5-phase dynamic contrast-enhanced T1fs fl3d TE/TR 1.56/4.6, Gadolinium-DTPA, slice 4 mm). Consensus reading of both modalities was used as reference. Tumour nodules were analyzed with respect to number, size, and location.

Results: In total, 162 tumour nodules were detected by consensus reading. MRI detected significantly more tumour nodules (159 vs 123, P < 0.001) compared to MDCT, with the best sensitivity for early arterial phase MRI. False-negative CT findings included nodules < or = 5 mm ( n = 5), < or = 10 mm ( n = 17), < or = 15 mm ( n = 12 ), < or = 20 mm ( n = 4 ), and 1 nodule > 20 mm. MRI missed 2 nodules < or = 10 mm and 1 nodule < or = 15 mm. On MRI, nodule diameters were greater than on CT (29.2 +/- 25.1 mm, range 5-140 mm vs 24.1 +/- 22.7 mm, range 4-129 mm, P < 0.005). In 2 patients, MDCT showed only unilobar tumour spread, whereas MRI revealed additional nodules in the contralateral lobe. Detection of these nodules could have changed the therapeutic strategy.

Conclusion: Contrast-enhanced MRI is superior to 64-row MDCT for the detection of HCC nodules. Patients should be allocated to interventional or operative treatment according to a dedicated MRI-protocol.

Figure 1

71-year-old man with biopsy-proven hepatocellular carcinoma (HCC). Detection of an additional tumor nodule by magnetic resonance imaging (MRI), size 12 mm (size category ≤ 15 mm). Multidetector computed tomography (MDCT) demonstrates two hypervascularized tumor nodules in the contrast-enhanced arterial phase (A, arrow) but not in the portal venous phase (B, arrow). MRI arterial phase depicts one more tumor nodule (arrows) in the T2w (C) and the T1w contrast-enhanced early arterial phase (D).

Figure 2

70-year-old man with biopsy-proven HCC. Detection of an additional tumour nodule by MRI, size 10 mm (size category ≤ 10 mm). MDCT does not show any contrast enhancement in the arterial (A, arrow) or portal venous phase (B, arrow). MRI arterial phase depicts one more tumour nodule (C, arrow) which is hypo- to isointense on the portal venous phase (D, arrow).

Figure 3

70-year-old man with biopsy-proven HCC. Detection of an additional tumour nodule by MRI, size 19 mm (size category ≤ 20 mm). MDCT demonstrates no hypervascular enhancement in the contrast-enhanced arterial phase (A, arrow) or the portal venous phase (B, arrow). MRI arterial phase depicts a hypervascularized area in the T1w phase (C, arrow) which became isointense in the portal venous phase (D, arrow).

Figure 4

82-year-old man with biopsy-proven HCC. Detection of an additional tumour nodule by MDCT. The contrast-enhanced arterial phase MDCT demonstrates large tumours in the right liver lobe and one additional hypervascularized nodule in segment 4 (A, arrow) but not in the portal venous phase (B, arrow). Contrast-enhanced MRI depicts the large tumours in the right liver lobe but not in segment 4 (arrows) in early arterial phase (C) and portal venous phase (D).

Figure 5

Correlation of tumor sizes measured with MDCT and MRI using a scatterplot. There is a tendency towards greater diameters on MRI compared to MDCT (y = 1.08x + 3.2).

Figure 6

54-year-old man with biopsy-proven HCC. False-negative finding in the two modalities. Contrast-enhanced early arterial and portal venous phase MDCT (A) and arterial and portal venous phase MRI (B) detected a 3 cm tumour in the right liver lobe (A, B, arrows) but failed to detect another tumour nodule at the posterior surface of the left liver lobe. The explanted liver specimen clearly depicts this additional 2 cm tumour nodule on gross-sectional pathology (C, arrow) and histology (D, 10 × magnification, HE staining).