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. 2017 May 2;8(18):29741-29750.
doi: 10.18632/oncotarget.15712.

Contrast-enhanced computed tomography plus gadolinium-ethoxybenzyl diethylenetriamine pentaacetic acid-enhanced magnetic resonance imaging for gross classification of hepatocellular carcinoma

Chuang Chen  1   2 , Hui Zhao  3 , Xu Fu  4 , LuoShun Huang  4 , Min Tang  5 , XiaoPeng Yan  4 , ShiQuan Sun  4 , WenJun Jia  4 , Liang Mao  4 , Jiong Shi  6 , Jun Chen  6 , Jian He  5 , Jin Zhu  7   8 , YuDong Qiu  1   4
Affiliations

Contrast-enhanced computed tomography plus gadolinium-ethoxybenzyl diethylenetriamine pentaacetic acid-enhanced magnetic resonance imaging for gross classification of hepatocellular carcinoma

Chuang Chen et al. Oncotarget. .

Abstract

Accurate gross classification through imaging is critical for determination of hepatocellular carcinoma (HCC) patient prognoses and treatment strategies. The present retrospective study evaluated the utility of contrast-enhanced computed tomography (CE-CT) combined with gadolinium-ethoxybenzyl diethylenetriamine pentaacetic acid-enhanced magnetic resonance imaging (EOB-MRI) for diagnosis and classification of HCCs prior to surgery. Ninety-four surgically resected HCC nodules were classified as simple nodular (SN), SN with extranodular growth (SN-EG), confluent multinodular (CMN), or infiltrative (IF) types. SN-EG, CMN and IF samples were grouped as non-SN. The abilities of the two imaging modalities to differentiate non-SN from SN HCCs were assessed using the EOB-MRI hepatobiliary phase and CE-CT arterial, portal, and equilibrium phases. Areas under the ROC curves for non-SN diagnoses were 0.765 (95% confidence interval [CI]: 0.666-0.846) for CE-CT, 0.877 (95% CI: 0.793-0.936) for EOB-MRI, and 0.908 (95% CI: 0.830-0.958) for CE-CT plus EOB-MRI. Sensitivities, specificities, and accuracies with respect to identification of non-SN tumors of all sizes were 71.4%, 81.6%, and 75.5% for CE-CT; 96.4%, 78.9%, and 89.3% for EOB-MRI; and 98.2%, 84.2%, and 92.5% for CE-CT plus EOB-MRI. These results show that CE-CT combined with EOB-MRI offers a more accurate imaging evaluation for HCC gross classification than either modality alone.

Keywords: CE-CT; EOB-MRI; gross classification; hepatocellular carcinoma; imaging.

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Conflict of interest statement

CONFLICTS OF INTEREST

The authors have no conflicts of interest to disclose.

Figures

Figure 1
Figure 1. (A) A 66-year-old man with cirrhosis related to hepatitis B
The gross classification was SN-IM based on pathological examination. Two images following specimen were arterial phase of CE-CT and hepatobiliary phase of EOB-MRI. (B) A 62-year-old man with cirrhosis related to hepatitis B. The gross classification was SN-DM based on pathological examination. Two images following specimen were equilibrium phase of CE-CT and hepatobiliary phase of EOB-MRI.
Figure 2
Figure 2. (A) A 42-year-old man with cirrhosis related to hepatitis B
The gross classification was SN-EG based on pathological examination. Two images following specimen were arterial phase of CE-CT and hepatobiliary phase of EOB-MRI. (B) A 52-year-old man with cirrhosis related to hepatitis B. The gross classification was CMN based on pathological examination. Two images following specimen were portal phase of CE-CT and hepatobiliary phase of EOB-MRI. (C) A 64-year-old man with cirrhosis related to hepatitis B. The gross classification was IF based on pathological examination. Two images following specimen were portal phase of CE-CT and hepatobiliary phase of EOB-MRI.
Figure 3
Figure 3
ROC curves of CE-CT, EOB-MRI and CE-CT plus EOB-MRI for diagnosing non-SN ((A), all sizes of HCCs; (B), Sizes of HCCs ≤ 3.0 cm; (C), Sizes of HCCs > 3.0 cm).
Figure 4
Figure 4. Summaries of the five gross classification of hepatocellular carcinoma
Top schemas show the schematic diagram of the five gross classification as follows: (A) SN-IM, (B) SN-DM, (C) SN-EG, (D) CMN, and (E) IF. Middle images show the arterial phase, portal phase or equilibrium phase of CE-CT. Bottom images show the hepatobiliary phase of EOB-MRI.
See this image and copyright information in PMC

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