Benefit of double contrast MRI in diagnosis of hepatocellular carcinoma in patients with chronic liver diseases

Objective: To assess the benefit on diagnosis of hepatocellular carcinoma (HCC) in patients with chronic liver disease or cirrhosis with double contrast MR imaging compared to the routine gadolinium-based MR imaging. Material and Method: Seventy-one consecutive patients with cirrhosis or chronic hepatitis underwent multiphase, gadoliniumenhanced liver MRI examination and sequentially superparamagnetic iron oxide (SPIO)-enhanced images. The presence signal intensities of lesions on non-contrast sequences, dynamic gadolinium-enhanced images and delayed 10-min post-SPIO T2*-weighted images were recorded. Results: Among 27 patients, 15 HCCs from 12 patients were diagnosed by surgical (n = 7) and non-surgical (n = 8) proofs. The overall sensitivity, specificity, positive predictive value, and negative predictive value of double contrast-enhanced images in 12 patients were 83.3% (95% CI: 58.5, 96.2), 33.3% (95% CI: 5.4, 88.4), 88.2% (95% CI: 63.5, 98.2), and 25% (95% CI: 4.1, 79.6) and these of gadolinium-enhanced images were 72.2% (95% CI: 46.5, 90.2), 33.3% (95% CI: 5.4, 88.4), 86.6% (95% CI: 59.5, 97.9), and 16.6% (95% CI: 2.7, 63.9), respectively. There were two benign hepatic nodules (1 adenoma, 1 dysplastic nodule) suspected as HCCs on MR images and two surgically proven-HCCs, invisible on gadolinium-enhanced images, detected as defect on only delayed 10-min post-SPIO T2*-weighted images. Conclusion: SPIO-enhanced images in double contrast-enhanced MR imaging had an additional value on HCC detection, compared to gadolinium-enhanced MR imaging, in patients with chronic liver disease or cirrhosis.