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Hepatocellular Carcinoma and Dysplastic Nodules in Patients with Cirrhosis: Prospective Diagnosis with MR Imaging and Explantation Correlation¹

¹ From the Departments of Radiology (G.A.K., V.S.L., J.C.W., N.M.R.), Pathology (N.D.T.), and Transplant Surgery (T.D., L.W.T.,) and the Kaplan Comprehensive Cancer Center (G.A.K.), New York University Medical Center, 530 First Ave, New York, NY 10016. Received August 14, 2000; revision requested September 20; revision received October 4; accepted November 9. Supported by an RSNA Research Grant and an award from the Society of Computed Tomography and Magnetic Resonance. Address correspondence to G.A.K. (e-mail: glenn.krinsky@med.nyu.edu)

PURPOSE: To determine the sensitivity and specificity of magnetic resonance (MR) imaging for detection of hepatocellular carcinoma (HCC) and dysplastic nodules (DNs) by using explantation correlation in patients with cirrhosis and no known HCC.

MATERIALS AND METHODS: Seventy-one patients without a known history of HCC who underwent MR imaging and subsequent transplantation within 90 days were examined. Breath-hold turbo short inversion time inversion-recovery and/or T2-weighted turbo spin-echo MR images were obtained. Dynamic two- or three-dimensional gadolinium-enhanced gradient-echo MR images were obtained in the hepatic arterial, portal venous, and equilibrium phases. Prospective MR image interpretations were compared directly with explanted liver pathologic results.

RESULTS: Eleven (15%) of 71 patients had hepatic malignancies; MR imaging enabled diagnosis of tumor in six (54%) of 11 patients. On a lesion-by-lesion basis, MR imaging depicted 11 of 20 hepatic neoplasms, for an overall sensitivity of 55%. MR imaging depicted four (80%) of five lesions larger than 2 cm, six (50%) of 12 lesions 1–2 cm, and one (33%) of three lesions smaller than 1 cm. MR imaging depicted only nine (15%) of 59 DNs. The specificities of MR imaging for detection of HCC and DNs on a per patient basis were 60 (86%) of 70 patients and 53 (85%) of 62 patients, respectively.

CONCLUSION: MR imaging is insensitive for the diagnosis of small (<2-cm) HCCs and DNs.

Index terms: Liver, cirrhosis, 761.794 • Liver, nodules, 761.3198 • Liver, transplantation, 761.459 • Liver neoplasms, 761.31, 761.321, 761.323 • Liver neoplasms, MR, 761.121411, 761.121412, 761.121413, 761.121415, 761.12143

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