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Can the Patient With Cirrhosis Be Imaged for Hepatocellular Carcinoma Without Gadolinium?: Comparison of Combined T2-Weighted, T2*-Weighted, and Diffusion-Weighted MRI With Gadolinium-Enhanced MRI Using Liver Explantation Standard

Hardie, Andrew D. MD; Kizziah, Michael K. MD; Rissing, Michael S. MD

Journal of Computer Assisted Tomography: November/December 2011 - Volume 35 - Issue 6 - p 711–715
doi: 10.1097/RCT.0b013e31823421ac
Original Article

Purpose: This study aimed to evaluate a non–gadolinium-enhanced magnetic resonance imaging (MRI) protocol including T2-weighted, T2*-weighted, and diffusion-weighted MRI sequences for identifying hepatocellular carcinoma (HCC) with liver explantation as the reference standard. Also, a stand-alone pre– and dynamic post–gadolinium-enhanced liver MRI data set was interpreted from the available patient data for relative comparison purposes.

Materials and Methods: A retrospective review identified 37 appropriately selected liver transplant patients who had had preoperative MRI. Two data sets were created from the MRI studies: (1) non–gadolinium-enhanced (including T2-weighted, T2*-weighted, and diffusion-weighted sequences) and (2) pre– and dynamic post–gadolinium-enhanced (3-dimensional T1-weighted gradient recalled echo) and were presented to 2 independent, blinded observers. A separate blinded observer assessed the pathologic results from liver explantation to establish the reference standard.

Results: On explant pathology, 21 of 37 patients had 31 HCC (mean [SD] largest diameter, 19 [9] cm; range, 7–40 mm). Per-lesion sensitivity of non–gadolinium-enhanced MRI for identifying HCC was 52% (reader 1) and 55% (reader 2), and specificity was 90% (reader 1) and 88% (reader 2). Per-lesion sensitivity of the stand-alone pre– and dynamic post–gadolinium-enhanced MRI was 84% (reader 1) and 81% (reader 2), and specificity was 62% (reader 1) and 65% (reader 2).

Conclusions: Non–gadolinium-enhanced MRI had a moderate sensitivity for HCC but had a high specificity. Although non–gadolinium-enhanced MRI cannot be recommended as a primary imaging approach for HCC, the results demonstrate the contribution of non–gadolinium-enhanced sequences to imaging of HCC. A non–gadolinium-enhanced MRI protocol may have a diagnostic value when gadolinium cannot be administered.

From the Department of Radiology and Radiological Science, Medical University of South Carolina, Charleston, SC.

Received for publication June 3, 2011; accepted August 23, 2011.

Reprints: Andrew D. Hardie, MD, Department of Radiology and Radiological Science, Medical University of South Carolina, 25 Courtenay Dr, MSC 226, Charleston SC 29401 (e-mail:

The authors report no conflicts of interest.

© 2011 Lippincott Williams & Wilkins, Inc.