New Liver MR Imaging Hallmarks for Small Hepatocellular Carcinoma Screening and Diagnosing in High-Risk Patients

Early detection and diagnosis of hepatocellular carcinoma (HCC) is essential for prognosis; however, the imaging hallmarks for tumor detection and diagnosis has remained the same for years despite the use of many new immerging imaging methods. This study aimed to evaluate the detection performance of hepatic nodules in high risk patients using either hepatobiliary specific contrast (HBSC) agent or extracellular contrast agent (ECA), and further to compare the diagnostic performances for hepatocellular carcinoma (HCC) using different diagnostic criteria with the histopathological results as reference standard.

This prospective study included 247 nodules in 222 patients (mean age, 53.32 ± 10.84 years; range, 22-79 years). The detection performance and imaging features of each nodule were evaluated in all MR sequences by three experienced abdominal radiologists. The detection performance of each nodule on all MR sequences were compared and further the diagnostic performance of various diagnostic criteria were evaluated.

For those patients who underwent ECA-MRI, the conventional imaging hallmark of "AP + PVP and/or DP" was recommended, as 60.19% diagnostic sensitivity, 80.95% specificity and 100% lesion detection rate. Additionally, for those patients who underwent HBSC-MRI, the diagnostic criteria of "DWI + HBP" was recommended. This diagnostic criteria demonstrated, both in all tumor size and for nodules ≤2 cm, higher sensitivity (93.07 and 90.16%, all p <0.05, respectively) and slightly lower specificity (64.71 and 87.50%, all p >0.05, respectively) than that of the European Association for the Study of the Liver (EASL) criteria.

Different abbreviated MR protocols were recommended for patients using either ECA or HBSC. These provided imaging settings demonstrated high lesion detection rate and diagnostic performance for HCC.