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Comparative Study
. 2018 Jan 15;18(1):10.
doi: 10.1186/s12876-017-0719-1.

Efficacy comparison of multi-phase CT and hepatotropic contrast-enhanced MRI in the differential diagnosis of focal nodular hyperplasia: a prospective cohort study

Tomasz K Nowicki  1 , Karolina Markiet  2 , Ewa Izycka-Swieszewska  3 , Katarzyna Dziadziuszko  2 , Michal Studniarek  4 , Edyta Szurowska  2
Affiliations
Comparative Study

Efficacy comparison of multi-phase CT and hepatotropic contrast-enhanced MRI in the differential diagnosis of focal nodular hyperplasia: a prospective cohort study

Tomasz K Nowicki et al. BMC Gastroenterol. .

Abstract

Background: Different clinical behaviour influences the importance of differentiating focal nodular hyperplasia (FNH) from other focal liver lesions (FLLs). The aim of this study was to compare the efficacy of contrast-enhanced CT and MRI in the diagnosis of FNH.

Methods: 157 patients with equivocal FLLs detected in ultrasonography subsequently underwent multi-phase CT and MRI with the use of hepatotropic contrast agent (Gd-BOPTA) in a 1.5 T scanner. Examinations were evaluated by three independent readers. Diagnostic efficacy of different radiological signs of FNH in both CT and MRI was compared and AFROC analysis was performed.

Results: 4 hepatocellular adenomas, 95 hepatocellular carcinomas, 98 hemangiomas, 138 metastases and 45 FNHs were diagnosed. In both CT and MRI the radiological sign of the highest accuracy was the presence of the central scar within FNH (0.93 and 0.96 relatively). The sum of two radiological signs in MRI: homogeneous enhancement in hepatic arterial phase (HAP) and enhancing lesion in hepatobiliary phase (HBP) was characterized with high values of sensitivity (0.89), specificity (0.97), PPV (0.82), NPV (0.98) and accuracy (0.96). After inclusion of clinical data into analysis the best discriminating feature in MRI was the presence of enhancing lesion in HBP in patients without cirrhosis. In this regard, efficacy parameters increased to 1.00, 0.99, 0.94, 1.00 and 0.99 accordingly. The area under the curve in AFROC analysis of MRI performance was significantly larger than of CT (p = 0.0145).

Conclusion: Gd-BOPTA-enhanced MRI is a more effective method in the differential diagnosis of FNH than multi-phase CT.

Keywords: AFROC; Computed tomography; Differential diagnosis; Focal nodular hyperplasia; Gadobenate Dimeglumine; Hepatobiliary phase; Magnetic resonance imaging.

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Conflict of interest statement

Ethics approval and consent to participate

The research was approved by The Independent Bioethics Committee for Scientific Research of the Medical University of Gdansk, Poland (NKEBN/649/01–02). All patients gave their informed written consent to participate.

Consent for publication

Not applicable.

Competing interests

The authors declare that they have no competing interests.

Publisher’s Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Figures

Fig. 1
Fig. 1
Flowchart of patients’ inclusion in the analysis. FLLs – focal liver lesions, pts – patients
Fig. 2
Fig. 2
MRI examination of a 33-year-old female; all the images are in the axial plane. Fig. a and b present slightly hypointense FNH in segment IV of the liver (arrow) on T2- and T1-weighted images. Central scar (small arrow) is hyperintense on T2-weighted images (Fig a). In hepatic arterial phase, the lobulated lesion presents strong enhancement (Fig. c). In portal venous phase (Fig. d) and equilibrium phase (Fig. e) the lesion stays hyperintense, however, the enhancement is weaker than in hepatic arterial phase. In hepatobiliary phase (Fig. f) the lesion is hyperintense and enhancement of the scar is visible (arrow)
Fig. 3
Fig. 3
Mean AFROC plot for multi-phase multi-detector CT (a) and Gd-BOPTA-enhanced MRI (b) in the diagnosis of FNH. LLF – lesion location fraction, FPF – false positive fraction
See this image and copyright information in PMC

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