Is gadoxetic acid-enhanced MRI limited in tumor characterization for patients with chronic liver disease?

Purpose: There are pros and cons to the use of gadoxetic acid in hepatocellular carcinoma (HCC) workup due to the potential for high false positive diagnosis. This study was conducted to investigate the preoperative diagnostic performance of gadoxetic acid-enhanced MRI protocol including diffusion-weighted imaging (DWI) with emphasis on tumor characterization developed in high risk HCC patients. Materials and methods: We included 144 patients (102 men, 42 women; age range 33-74. years) with chronic viral hepatitis or cirrhosis and 183 focal hepatic tumors (size range, 0.4-11.0. cm; mean, 3.2. cm), including 148 HCCs, 13 cholangiocarcinomas, 12 hemangiomas, three hepatocellular adenomas, two focal nodular hyperplasias, and five other tumors. All patients underwent gadoxetic acid-enhanced MRI protocol with DWI. MRIs were independently interpreted by three observers for the detection and characterization of hepatic tumors. Results: Sensitivities for detecting all 183 liver tumors were 98.4%, 97.8%, and 96.2% for each observer, respectively, with a 97.5% for pooled data. Among 183 hepatic tumors, 91.3% (n. =. 167), 87.4% (n. =. 160), and 86.9% (n. =. 159) were correctly characterized according to their reference standard by each observer, respectively. In 13 cholangiocarcinomas, one to three were misinterpreted as HCC, and the remaining tumors were correctly characterized by each observer. The accuracies (Az) of MRI for HCC diagnosis were 0.952 for observer 1, 0.906 for observer 2, and 0.910 for observer 3, with 0.922 for pooled data. There was good inter-observer agreement. Conclusion: The gadoxetic acid-enhanced MRI including DWI showed a reasonable performance for tumor characterization with high sensitivity for tumor detection in patients with chronic liver disease, despite concerns of high false positive diagnosis of hypervascular tumors.