Performance of Gd-EOB-DTPA-enhanced MRI for the diagnosis of LI-RADS 4 category hepatocellular carcinoma nodules with different diameters

In 2011, the American College of Radiology released a standardized reporting and data collection system, named Liver Imaging Reporting and Data System (LI-RADS), to improve the consistency of diagnostic imaging examinations of hepatocellular carcinoma (HCC). When the LI-RADS guideline was updated in 2014, hepatobiliary contrast agents, including gadoxetate acid (Gd-EOB-DTPA), were incorporated into the system. However, the diagnostic performance of Gd-EOB-DTPA-enhanced magnetic resonance imaging (MRI) for nodules of different diameters has not been addressed. In the present study, a total of 263 LI-RADS 4 category hepatic nodules were examined blindly and independently by two radiologists. All nodules were divided into two datasets: Set 1 (n=86) that included nodules with iso/hypo-intensity in the arterial phase (HCC, n=42; non-HCC, n=44) and set 2 (n=177) that included nodules with hyper-intensity in the arterial phase (HCC, n=131; non-HCC, n=46). The diagnostic performance of Gd-EOB-DTPA-enhanced MRI for evaluation of nodules with different diameters was evaluated. The present study revealed that the diagnostic performance of Gd-EOB-enhanced MRI of larger nodules (>2 cm) was higher compared with (<2 cm) smaller nodules. The FPR of large nodules (>2 cm) with a hypervascular pattern was lower compared with smaller nodules (<2 cm) with hypovascular pattern. In conclusion, Gd-EOB-enhanced MRI is useful for the diagnosis of HCC where hypervascular LI-RADS 4 nodules are >2 cm in diameter. However, Gd-EOB-enhanced MRI may be of limited use for the assessment of nodules that <20 mm due to low diagnostic performance and high FPR.