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

13 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

Keywords

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

ASJC Scopus subject areas

  • Radiology Nuclear Medicine and imaging

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