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Double-Contrast MRI for Accurate Staging of Hepatocellular Carcinoma in Patients with Cirrhosis

¹ Department of Radiology, Division of Body Imaging, University of California, San Diego, 200 W Arbor Dr., San Diego, CA 92103-8756.
² Department of Internal Medicine, University of California, San Diego, San Diego, CA.

OBJECTIVE. The aim of this study was to evaluate the accuracy of a double-contrast MRI protocol in staging of hepatocellular carcinoma (HCC) in patients with cirrhosis.

MATERIALS AND METHODS. This cross-sectional study was performed at a tertiary liver care center. Forty-eight patients with cirrhosis underwent double-contrast MRI for clinical care and liver transplantation. For each MRI examination, superparamagnetic iron oxide was infused, and 2D T2^*-weighted spoiled gradient-recalled echo and T2-weighted echo-train spin-echo MR images were obtained for assessment of phagocytic function. Immediately afterward, a low-molecular-weight gadolinium compound was injected, and 3D T1-weighted spoiled gradient-recalled echo images were acquired dynamically for assessment of vascularity. Two blinded radiologists independently reviewed all MR images and assigned per-lesion and perpatient cancer confidence scores to determine the American Liver Tumor Study Group tumor stage. The imaging-based cancer scores and tumor stages were correlated with pathology reports. Performance parameters were computed for imaging-based measurements.

RESULTS. Of the 48 study subjects, 25 had HCC (three, T1; 18, T2; one, T3; one, T4a; two, T4b). In total, there were 37 HCC nodules. The accuracy of MRI in prediction of pathologic tumor stage was 81-85% depending on the radiologist. Per-patient and per-lesion sensitivity in the diagnosis of HCC were 96% and 81% for one radiologist and 96% and 89% for the other.

CONCLUSION. A double-contrast MRI protocol has high accuracy in staging of HCC in patients with cirrhosis.

Keywords: hepatocellular carcinoma • liver • MRI • sensitivity • staging

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