You could be reading the full-text of this article now if you...

If you have access to this article through your institution,
you can view this article in

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:
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.

Author Information

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.