Washout appearance in Gd-EOB-DTPA-enhanced MR imaging: A differentiating feature between hepatocellular carcinoma with paradoxical uptake on the hepatobiliary phase and focal nodular hyperplasia-like nodules

Jeong Woo Kim, Chang-Hee Lee, Soo Byn Kim, Bit Na Park, Yang Shin Park, Jongmee Lee, Cheol Min Park

Research output: Contribution to journalArticle

5 Citations (Scopus)

Abstract

Purpose: To identify the most reliable imaging features for differentiating hepatocellular carcinoma with paradoxical uptake on the hepatobiliary phase (HCCpara) from focal nodular hyperplasia (FNH)-like nodules using Gd-EOB-DTPA-enhanced MRI. Materials and Methods: This was a retrospective study. Twenty patients with HCCpara and 21 patients with FNH-like nodules were included. The following MRI features were evaluated using 3.0 Tesla unit by two radiologists: signal intensity (SI) on T1-, T2-, and diffusion-weighted imaging (DWI), arterial enhancement pattern, washout appearance on the portal venous phase (PVP) and/or transitional phase (TP), uptake pattern on the hepatobiliary phase (HBP), “T2 scar,” “EOB scar,” and chemical shift on in- and out-of-phase images. Multivariate logistic regression analysis was performed to assess MRI features for prediction of HCCpara. Results: Compared with FNH-like nodules, HCCpara had significantly more frequent heterogeneous T1 SI (P < 0.0001), T2 hyperintensity (P = 0.032), heterogeneous arterial enhancement (P < 0.0001), washout appearance on the PVP and/or TP (P < 0.0001), heterogeneous uptake on the HBP (P < 0.0001), absence of “EOB scar” (P < 0.0001), and hyperintensity on DWI (P = 0.004). Multivariate logistic regression analysis revealed washout appearance as the only independent imaging feature associated with HCCpara (odds ratio, 7.019; P = 0.042). Washout appearance also showed the best diagnostic performance with a sensitivity of 90% and a specificity of 100%. Conclusion: Washout appearance on the PVP and/or TP is the most reliable imaging feature for differentiating HCCpara from FNH-like nodules. Level of Evidence: 3. J. MAGN. RESON. IMAGING 2017;45:1599–1608.

Original languageEnglish
Pages (from-to)1599-1608
Number of pages10
JournalJournal of Magnetic Resonance Imaging
Volume45
Issue number6
DOIs
Publication statusPublished - 2017 Jun 1

Fingerprint

Focal Nodular Hyperplasia
Hepatocellular Carcinoma
Cicatrix
Logistic Models
Regression Analysis
Retrospective Studies
Odds Ratio
gadolinium ethoxybenzyl DTPA

Keywords

  • FNH like nodule
  • gadoxetic acid
  • hepatocellular carcinoma
  • magnetic resonance imaging
  • washout

ASJC Scopus subject areas

  • Radiology Nuclear Medicine and imaging

Cite this

@article{38fe12c7630547b6b0bb659a9aa79a83,
title = "Washout appearance in Gd-EOB-DTPA-enhanced MR imaging: A differentiating feature between hepatocellular carcinoma with paradoxical uptake on the hepatobiliary phase and focal nodular hyperplasia-like nodules",
abstract = "Purpose: To identify the most reliable imaging features for differentiating hepatocellular carcinoma with paradoxical uptake on the hepatobiliary phase (HCCpara) from focal nodular hyperplasia (FNH)-like nodules using Gd-EOB-DTPA-enhanced MRI. Materials and Methods: This was a retrospective study. Twenty patients with HCCpara and 21 patients with FNH-like nodules were included. The following MRI features were evaluated using 3.0 Tesla unit by two radiologists: signal intensity (SI) on T1-, T2-, and diffusion-weighted imaging (DWI), arterial enhancement pattern, washout appearance on the portal venous phase (PVP) and/or transitional phase (TP), uptake pattern on the hepatobiliary phase (HBP), “T2 scar,” “EOB scar,” and chemical shift on in- and out-of-phase images. Multivariate logistic regression analysis was performed to assess MRI features for prediction of HCCpara. Results: Compared with FNH-like nodules, HCCpara had significantly more frequent heterogeneous T1 SI (P < 0.0001), T2 hyperintensity (P = 0.032), heterogeneous arterial enhancement (P < 0.0001), washout appearance on the PVP and/or TP (P < 0.0001), heterogeneous uptake on the HBP (P < 0.0001), absence of “EOB scar” (P < 0.0001), and hyperintensity on DWI (P = 0.004). Multivariate logistic regression analysis revealed washout appearance as the only independent imaging feature associated with HCCpara (odds ratio, 7.019; P = 0.042). Washout appearance also showed the best diagnostic performance with a sensitivity of 90{\%} and a specificity of 100{\%}. Conclusion: Washout appearance on the PVP and/or TP is the most reliable imaging feature for differentiating HCCpara from FNH-like nodules. Level of Evidence: 3. J. MAGN. RESON. IMAGING 2017;45:1599–1608.",
keywords = "FNH like nodule, gadoxetic acid, hepatocellular carcinoma, magnetic resonance imaging, washout",
author = "Kim, {Jeong Woo} and Chang-Hee Lee and Kim, {Soo Byn} and Park, {Bit Na} and Park, {Yang Shin} and Jongmee Lee and Park, {Cheol Min}",
year = "2017",
month = "6",
day = "1",
doi = "10.1002/jmri.25493",
language = "English",
volume = "45",
pages = "1599--1608",
journal = "Journal of Magnetic Resonance Imaging",
issn = "1053-1807",
publisher = "John Wiley and Sons Inc.",
number = "6",

}

TY - JOUR

T1 - Washout appearance in Gd-EOB-DTPA-enhanced MR imaging

T2 - A differentiating feature between hepatocellular carcinoma with paradoxical uptake on the hepatobiliary phase and focal nodular hyperplasia-like nodules

AU - Kim, Jeong Woo

AU - Lee, Chang-Hee

AU - Kim, Soo Byn

AU - Park, Bit Na

AU - Park, Yang Shin

AU - Lee, Jongmee

AU - Park, Cheol Min

PY - 2017/6/1

Y1 - 2017/6/1

N2 - Purpose: To identify the most reliable imaging features for differentiating hepatocellular carcinoma with paradoxical uptake on the hepatobiliary phase (HCCpara) from focal nodular hyperplasia (FNH)-like nodules using Gd-EOB-DTPA-enhanced MRI. Materials and Methods: This was a retrospective study. Twenty patients with HCCpara and 21 patients with FNH-like nodules were included. The following MRI features were evaluated using 3.0 Tesla unit by two radiologists: signal intensity (SI) on T1-, T2-, and diffusion-weighted imaging (DWI), arterial enhancement pattern, washout appearance on the portal venous phase (PVP) and/or transitional phase (TP), uptake pattern on the hepatobiliary phase (HBP), “T2 scar,” “EOB scar,” and chemical shift on in- and out-of-phase images. Multivariate logistic regression analysis was performed to assess MRI features for prediction of HCCpara. Results: Compared with FNH-like nodules, HCCpara had significantly more frequent heterogeneous T1 SI (P < 0.0001), T2 hyperintensity (P = 0.032), heterogeneous arterial enhancement (P < 0.0001), washout appearance on the PVP and/or TP (P < 0.0001), heterogeneous uptake on the HBP (P < 0.0001), absence of “EOB scar” (P < 0.0001), and hyperintensity on DWI (P = 0.004). Multivariate logistic regression analysis revealed washout appearance as the only independent imaging feature associated with HCCpara (odds ratio, 7.019; P = 0.042). Washout appearance also showed the best diagnostic performance with a sensitivity of 90% and a specificity of 100%. Conclusion: Washout appearance on the PVP and/or TP is the most reliable imaging feature for differentiating HCCpara from FNH-like nodules. Level of Evidence: 3. J. MAGN. RESON. IMAGING 2017;45:1599–1608.

AB - Purpose: To identify the most reliable imaging features for differentiating hepatocellular carcinoma with paradoxical uptake on the hepatobiliary phase (HCCpara) from focal nodular hyperplasia (FNH)-like nodules using Gd-EOB-DTPA-enhanced MRI. Materials and Methods: This was a retrospective study. Twenty patients with HCCpara and 21 patients with FNH-like nodules were included. The following MRI features were evaluated using 3.0 Tesla unit by two radiologists: signal intensity (SI) on T1-, T2-, and diffusion-weighted imaging (DWI), arterial enhancement pattern, washout appearance on the portal venous phase (PVP) and/or transitional phase (TP), uptake pattern on the hepatobiliary phase (HBP), “T2 scar,” “EOB scar,” and chemical shift on in- and out-of-phase images. Multivariate logistic regression analysis was performed to assess MRI features for prediction of HCCpara. Results: Compared with FNH-like nodules, HCCpara had significantly more frequent heterogeneous T1 SI (P < 0.0001), T2 hyperintensity (P = 0.032), heterogeneous arterial enhancement (P < 0.0001), washout appearance on the PVP and/or TP (P < 0.0001), heterogeneous uptake on the HBP (P < 0.0001), absence of “EOB scar” (P < 0.0001), and hyperintensity on DWI (P = 0.004). Multivariate logistic regression analysis revealed washout appearance as the only independent imaging feature associated with HCCpara (odds ratio, 7.019; P = 0.042). Washout appearance also showed the best diagnostic performance with a sensitivity of 90% and a specificity of 100%. Conclusion: Washout appearance on the PVP and/or TP is the most reliable imaging feature for differentiating HCCpara from FNH-like nodules. Level of Evidence: 3. J. MAGN. RESON. IMAGING 2017;45:1599–1608.

KW - FNH like nodule

KW - gadoxetic acid

KW - hepatocellular carcinoma

KW - magnetic resonance imaging

KW - washout

UR - http://www.scopus.com/inward/record.url?scp=84991070858&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=84991070858&partnerID=8YFLogxK

U2 - 10.1002/jmri.25493

DO - 10.1002/jmri.25493

M3 - Article

C2 - 27726242

AN - SCOPUS:84991070858

VL - 45

SP - 1599

EP - 1608

JO - Journal of Magnetic Resonance Imaging

JF - Journal of Magnetic Resonance Imaging

SN - 1053-1807

IS - 6

ER -