Value of MR susceptibility weighted imaging for characterization of small hepatocellular carcinoma in cirrhotic livers / 中华放射学杂志

ABSTRACT

Objective To investigate the value of susceptibility?weighted imaging (SWI) for characterization of small hepatocellular carcinoma (sHCC) in cirrhotic livers. Methods Two hundred seventy?two patients suspiciousof HCC underwent conventional MR imaging and susceptibility?weighted imaging (SWI). Two hundred and five patients were excluded due to either size larger than 3.0 cm, no cirrhosis or HCC. Finally, a total of 84 hepatocellular nodules in 67 patients were included in this prospective study. There were 22 DNs in 12 cases, 8 DNs with HCC foci in 7 cases, and 54 overt HCCs in 48 cases. Two abdominal radiologists independently evaluated signal intensity and enhancing pattern using conventional MRI set and conventional MRI combining with SWI set. A five?point scale was performed to evaluate diagnostic confidence of HCC. Kappa analysis was performed to assess interobserver agreement of the two sets by two readers.The diagnostic performance and confidence level were compared for each image set,ROC was used to evaluate the diagnostic efficiency.Results Good interobserver agreement was identified with a Kappa value of 0.923 for conventional MRI set and 0.865 for conventional MRI combining with SWI set, respectively. The diagnostic sensitivity, specificity, accuracy, and area under the alternative?free response ROC (Az) were 80.6% and 80.6%, 81.8% and 77.3%, 81.0% and 79.8%, 0.804 and 0.782 using conventional MRI set, and 93.5%and 85.5%, 90.9%and 86.4%, 92.9%and 85.7%, 0.898 and 0.859 using conventional MRI combining with SWI set for reader 1 and reader 2, respectively.The diagnostic confidence level of conventional MRI combining with SWI set for diagnosis of HCC with less than 2 cm in size(n=36) was significantly higher than that of conventional MRI (reader 1, 3.86±0.47 vs 3.40±0.91;reader 2, 3.85±0.57 vs 3.41±0.92;t values were 3.733 and 2.468, P were 0.001 and 0.018).Conclusion SWI can provide additional valuable information and improve diagnostic performance for characterization of sHCC in cirrhotic livers.