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A Reproducible MRI-Based Quantitative Feature for Differentiating Dysplastic Nodules from Hepatocellular Carcinoma: A

Cheng Zhang¹, Shuyi Xie¹, Chuangxin Wang¹

¹Department of Radiology, Sun Yat-Sen University Cancer Center, Guangzhou, Guangdong, People's Republic of China.

Journal of Hepatocellular Carcinoma

|May 18, 2026

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A new Hepatobiliary-Arterial Intensity Ratio (HAIR) accurately differentiates well-differentiated hepatocellular carcinoma (HCC) from dysplastic nodules (DN), improving diagnostic accuracy and potentially reducing treatment delays.

Area of Science:

Hepatocellular Carcinoma (HCC) Research
Medical Imaging and Diagnostics
Oncology

Background:

Well-differentiated hepatocellular carcinoma (HCC) is frequently misdiagnosed as dysplastic nodules (DN) on radiological imaging.
This diagnostic challenge can lead to significant delays in initiating appropriate patient treatment.
There is a critical need for reproducible imaging features to distinguish between DN and HCC.

Purpose of the Study:

To develop and validate a novel, reproducible imaging feature for differentiating dysplastic nodules (DN) from hepatocellular carcinoma (HCC).
To assess the diagnostic performance of the proposed feature in distinguishing between DN and HCC in diverse patient cohorts.

Main Methods:

A multicenter study involving patients from four Chinese hospitals, divided into training and validation cohorts.

Keywords:

dysplastic nodule hepatocellular carcinoma magnetic resonance imaging quantitative imaging feature reproducibility

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Calculation of Hepatobiliary-Arterial Intensity Ratio (HAIR) using lesion intensity from arterial and hepatobiliary phases.

Analysis of Glypican-3 (GPC3) expression to correlate with HAIR and nodule differentiation. A Support Vector Machine (SVM) model was used for comparison.

Main Results:

The study included 116 patients with 120 lesions (52 DN, 68 HCC).
HAIR demonstrated a high Area Under the Curve (AUC) of 0.824 in the internal test cohort for DN/HCC differentiation, outperforming SVM (AUC 0.733).
HAIR showed statistical significance (p<0.01) in correlation with GPC3, and its efficacy was confirmed in an external validation cohort (AUC 0.667).

Conclusions:

The Hepatobiliary-Arterial Intensity Ratio (HAIR) offers a quantitative, reproducible, and interpretable method for differentiating dysplastic nodules from hepatocellular carcinoma.
HAIR has the potential to improve the diagnostic accuracy of imaging in HCC detection.
This novel feature can aid clinicians in timely and accurate diagnosis, potentially improving patient outcomes.