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1 Department of Radiology, MRI Section, University of Michigan, 1500 E. Medical
Center Dr., UH B2B311, Ann Arbor, MI 48109-0030.
2 Center for Statistical Consulting and Research, University of Michigan, Ann
Arbor, MI 48109-0030.
3 Department of Medicine, University of Michigan, Ann Arbor, MI
48109-0030.
OBJECTIVE. The objectives of our study were to identify independent clinical, demographic, and MR imaging correlates of malignancy in patients with cirrhosis and to develop a predictive model based on identified correlates of malignancy.
MATERIALS AND METHODS. Sixty examinations of 58 patients with biopsy
proof of lesions suggestive of hepatocellular carcinoma on MR imaging were
retrospectively reviewed. The signal intensity of the lesion on T2-weighted
imaging and dynamic gadoliniumenhanced imaging, the size of the lesion, and
the number of suspicious lesions were recorded; in addition, patient age and
sex, 
-fetoprotein level, and hepatitis C viral genotype were noted. The
association between malignancy and each predictor variable was evaluated using
the chi-square test or the two-group t test. The final logistic
regression model included the variables that were shown to have a significant
association with malignancy and the clinically relevant predictors. We used
the adjusted odds ratios to measure the strength of each association. The
discriminant ability of the model for detecting hepatic malignancy was
assessed using receiver operating characteristic curve analysis.
RESULTS. The prevalence of hepatic malignancy in our study
population was 64%. The area under the receiver operating characteristic curve
for the logistic regression model was 0.82. Venous washout (odds ratio = 9.2),
-fetoprotein level (odds ratio = 3.2), and number of lesions (odds
ratio = 1.5) were significant predictors for malignancy (p <
0.05). When arterial enhancement and venous washout were either both present
or both absent, -fetoprotein level contributed little to the prediction
of malignancy.
CONCLUSION. The MR characteristics of hepatic lesions during the
dynamic venous phase in conjunction with the serum -fetoprotein level
and number of lesions are predictors of hepatic malignancy. The use of these
predictors can facilitate explicit estimation of malignancy in individuals
with underlying cirrhosis, potentially improving clinical decision-making.
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