Using Gd-EOB-DTPA-enhanced 3-T MRI for the differentiation of infiltrative hepatocellular carcinoma and focal confluent fibrosis in liver cirrhosis

Purpose: The purpose of the study was to determine significant imaging features to differentiate between infiltrative hepatocellular carcinoma (HCC) and confluent fibrosis (CF) in liver cirrhosis using Gd-EOB-DTPA-enhanced 3-T magnetic resonance imaging. Material and methods: Nineteen infiltrative HCCs and eight CFs were included. We evaluated the difference in imaging findings and apparent diffusion coefficient (ADC) between the two entities. We compared T2-weighted image (WI) and hepatobiliary phase (HBP) in terms of the clarity of the lesion outer margin. Results: Seventeen infiltrative HCCs showed lobulated margin, while focal CFs showed either straight (n= 3) or irregular margins (n= 5) (P= .001). All infiltrative HCCs had intact or bulging contours, and all focal CFs showed capsular retraction (P= .001). Fourteen infiltrative HCCs and two focal CFs showed arterial enhancement (P= .035). The ADC of infiltrative HCCs was significantly lower than that of CFs (P= .001). Satellite nodules were noted in 10 infiltrative HCCs. In terms of outer margin clarity, infiltrative HCCs showed a more distinct margin on HBP than on T2-WI (P= .005), while these two sequences were not significantly different in focal CFs (P= 1.000). Conclusion: HBP improved the imaging characteristics of infiltrative HCC, allowing it to be distinguished from focal CF. Infiltrative HCC showed lower ADC values than focal CF. Lobular configuration, contour bulging, enhancement pattern, associated satellite nodules and portal vein thrombosis were still found to be highly suggestive MR findings for infiltrative HCC.