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MRI characteristics for the differential diagnosis of benign and malignant small solitary hypovascular hepatic nodules

Qian, Haizhen; Li, Shihong; Ji, Ming; Lin, Guangwu

European Journal of Gastroenterology & Hepatology: July 2016 - Volume 28 - Issue 7 - p 749–756
doi: 10.1097/MEG.0000000000000642
Original Articles: Hepatic Neoplasia

Purpose: To compare the MRI findings of benign and malignant solitary hypovascular hepatic nodules and identify the differentiating features.

Materials and methods: A total of 135 patients with solitary hypovascular hepatic lesions up to 3 cm (mass forming intrahepatic cholangiocarcinoma, n=29; metastases, n=26; inflammatory pseudotumors and solitary necrotic nodule, n=48; and hemangioma, n=32) were assessed. MRI findings were analyzed, and lesions were scored for peripheral and intratumoral appearance and enhancement patterns.

Results: Univariate and multivariate analyses showed that the most common findings for benign lesions were subcapsular, sharp margin, homogeneous, marked high signal on T2WI, mild hyperintensity on T2WI, increasing intensity of peripheral globular enhancement, and persistent central septum-like linear enhancement on delayed phase (P<0.05). An area under the curve of 0.955 was obtained for differentiating malignant from benign nodules using the combined imaging features of ill-defined margins, heterogeneity, decreasing intensity of peripheral rim-like enhancement, and central increasing intensity of patchy enhancement. Interobserver agreement was good, ranging from 0.72 to 1.00.

Conclusion: MRI may be a useful noninvasive method for determining whether hypovascular hepatic nodules are malignant or benign.

Department of Radiology, Huadong Hospital, Fudan University, Shanghai, China

* Shihong Li and Haizhen Qian contributed equally to the work of this article.

Correspondence to Guangwu Lin, PhD, MD, Department of Radiology, Huadong Hospital, Fudan University, No. 221 West Yan’an Road, Shanghai 200040, China Tel/fax: +86 021 62483180; e-mail:

This is an open-access article distributed under the terms of the Creative Commons Attribution-Non Commercial-No Derivatives License 4.0 (CCBY-NC-ND), where it is permissible to download and share the work provided it is properly cited. The work cannot be changed in any way or used commercially.

Received January 28, 2016

Accepted March 7, 2016

Copyright © 2016 Wolters Kluwer Health, Inc. All rights reserved.