ArticleEuropean radiology2023
An improved diagnostic algorithm for subcentimeter hepatocellular carcinoma on gadoxetic acid-enhanced MRI.
Article in European radiology, 2023. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 14 papers.
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Who cites it
14 citing papers in PubMed.
- Hepatobiliary phase imaging in HCC: revisiting diagnostic algorithms and clinical utility of gadoxetic acid-enhanced MRI across international guidelines.Insights into imaging · 2026Review
- The value of LI-RADS ancillary features and biomarker for hepatocellular carcinoma ≤ 30 mm in Western and Eastern guidelines on extracellular agent and gadoxetic acid-enhanced MRI.European radiology · 2026Article
- Performance comparison of gadoxetic and extracellular MRI in diagnosing subcentimeter recurrent HCC after hepatectomy: a modified algorithm.Insights into imaging · 2026Article
- [Expert consensus on overall standardized management of gadoxetate disodium-enhanced MRI examinations (version 2026)].Zhonghua gan zang bing za zhi = Zhonghua ganzangbing zazhi = Chinese journal of hepatology · 2026Article
- Comparison of Gd-EOB-DTPA-enhanced MRI versus multiphasic enhanced CT for detecting occult recurrence after curative ablation of hepatocellular carcinoma.Frontiers in oncology · 2026Article
- China Liver Cancer Guidelines for the Diagnosis and Treatment of Hepatocellular Carcinoma (2024 Edition).Liver cancer · 2025Article
- Enhanced diagnostic performance for subcentimeter hepatocellular carcinoma using a novel criterion integrating serum AFP levels and gadolinium-based contrast-enhanced MRI features.BMC medical imaging · 2025Article
- Early identification of hepatocellular carcinoma patients at high-risk of recurrence using the ADV score: a multicenter retrospective study.World journal of surgical oncology · 2024Article
- Value of magnetic resonance imaging for diagnosis of LR‑3 and LR-4 lesions coexisting with hepatocellular carcinoma.Abdominal radiology (New York) · 2024Article
- Diagnostic algorithm for subcentimeter hepatocellular carcinoma using alpha-fetoprotein and imaging features on gadoxetic acid-enhanced MRI.European radiology · 2024Article
- Subcentimeter hepatocellular carcinoma (HCC) on gadoxetic-acid-enhanced MRI: less frequent typical imaging features compared to 1-2 cm HCC but better prognosis after surgical resection.Abdominal radiology (New York) · 2023Observational
- Preoperative subcategorization based on magnetic resonance imaging in intrahepatic cholangiocarcinoma.Cancer imaging : the official publication of the International Cancer Imaging Society · 2023Article
- Prognosis of Primary Liver Cancer Based on LI-RADS Classification with Extracellular Agent-Enhanced MRI.Journal of hepatocellular carcinoma · 2023Article
- Subcentimeter Nodules with Diagnostic Hallmarks of Hepatocellular Carcinoma: Comparison of Pathological Features and Survival Outcomes with Nodules Measuring 1-2 cm.Journal of hepatocellular carcinoma · 2023Article
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Abstract
objectivesAccurate diagnosis of subcentimeter hepatocellular carcinoma (HCC) is a challenge also with gadoxetic acid-enhanced MRI (EOB-MRI). This study aimed to assess the diagnostic accuracy of the Liver Imaging Reporting and Data System (LI-RADS) for subcentimeter HCC and to determine whether new diagnostic criteria (washout either on portal venous phase (PVP) or transitional phase (TP)) would improve the diagnostic performance.
methodsWe evaluated 240 subcentimeter observations in 225 consecutive treatment-naïve patients at risk of HCC. Final diagnoses were 132 HCCs (all by pathology) and 108 non-HCC (41 by pathology and 67 by follow-up). Two radiologists assessed MR imaging features and assigned LI-RADS categories. A variety of diagnostic criteria were developed by combining significant MRI features based on washout on PVP or TP. Diagnostic performance was compared.
resultsNon-rim arterial phase hyperenhancement (non-rim APHE), washout on PVP or TP, and hepatobiliary-phase hypointensity were significant predictors for subcentimeter HCC diagnosis according to multivariable analysis. One criterion (non-rim APHE and washout on PVP or TP) yielded higher sensitivity (68.2% vs. 56.8%, p = 0.011) with comparable specificity (91.7% vs. 92.6%, p > 0.999) compared to the LR-4 category. This criterion had improved sensitivity (68.2% vs. 49.2%, p < 0.001) and slightly decreased specificity (91.7% vs. 94.4%, p = 0.250) compared to non-rim APHE with washout on PVP.
conclusionsLI-RADS exhibits modest diagnostic performance for subcentimeter HCC. Our new criterion (non-rim APHE and non-peripheral washout on PVP or TP) may increase the diagnostic sensitivity without compromised specificity compared to the LR-4 category. KEY POINTS: • The LR-4 category shows modest diagnostic performance for the diagnosis of subcentimeter HCC on EOB-MRI with a sensitivity and specificity of 56.8% and 92.6%, respectively. • Non-rim APHE, non-peripheral washout on PVP or TP, and HBP hypointensity were independent predictors for the diagnosis of subcentimeter HCC. • The combination of non-rim APHE and non-peripheral washout on PVP or TP improves the sensitivity from 56.8 to 68.2% (p = 0.011) with comparable specificity (91.7 vs. 92.6%, p > 0.999).
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