Small Nodule Detection in Cirrhotic Livers: Evaluation with ... : Journal of Computer Assisted Tomography (original) (raw)

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Small Nodule Detection in Cirrhotic Livers: Evaluation with US, Spiral CT, and MRI and Correlation with Pathologic Examination of Explanted Liver

Rode, Agnès; Bancel, Brigitte; Douek, Philippe; Chevallier, Michèle; Vilgrain, Valerie; Picaud, Georges; Henry, Luc; Berger, Françoise; Bizollon, Thierry; Gaudin, Jean-Louis; Ducerf, Christian

From the Departments of Radiology (A. Rode, P. Douek, and G. Picaud), Liver Transplantation (C. Ducerf), Anatomopathology (B. Bancel), and Gastroenterology (J.-L. Gaudin), Hôpital de la Croix Rousse, Department of Anatomopathology, Institut Meyrieux (M. Chevallier), Departments of Radiology (L. Henry) and Anatomopathology (F. Berger), Hôpital E. Herriot, and Department of Gastroenterology, Hôpital de l'Hôtel-Dieu (T. Bizollon), Lyon, and Department of Radiology, Hôpital Baujon, Paris (V. Vilgrain), France.

Address correspondence and reprint requests to Dr. A. Rode at Department of Radiology, Hôpital de la Croix Rousse, 103 Grande rue de la Croix Rousse, F-69317 Lyon, Cedex 04, France.

Abstract

Purpose

The purpose of this work was to evaluate the detection and characterization of nodules ≥8 mm and small hepatocellular carcinomas (HCCs) in liver cirrhosis.

Method

Pathologic examination and results of US, helical CT, and dynamic MRI with gadolinium were compared after orthotopic liver transplantation (OLT) of 43 cirrhotic patients. Nodules were classified as macroregenerative nodules (MRNs), borderline nodules (BNs), and HCC.

Results

Pathologic examination classified 69 nodules: 50 MRNs, 6 BNs, and 13 HCCs. Sensitivities of MRN, BN, and HCC detection were, respectively, for US imaging 2% (1/50), 33.3% (2/6), and 46.2% (6/13); for helical CT 2% (1/50), 50% (3/6), and 53.8% (7/13); and for MRI 42% (21/50), 50% (3/6), and 76.9% (10/13). MRI detected 21 MRNs. They presented on T1/T2-weighted images as hyperintense/hypointense (n = 8), hyperintense/isointense (n = 7), hypointense/hypointense (n = 4), hypointense/isointense (n = 1), and hypointense depicted only on echo planar imaging (n = 1). The three detected BNs were hyperintense/hypointense nodules. The 10 detected HCCs appeared hyperintense/isointense (n = 7), hyperintense/hypointense (n = 2), and hypointense/isointense (n = 1). None of the MRNs but eight HCCs and one BN were enhanced after gadolinium injection.

Conclusion

Contrast-enhanced MRI is the most sensitive technique for detecting liver nodules. No MR signal intensity pattern characteristic of small HCCs enables differentiation from benign nodules, however. Gadolinium enhancement is the most sensitive and specific characteristic of HCC.