ArticleEuropean radiology2024
Diagnostic algorithm for subcentimeter hepatocellular carcinoma using alpha-fetoprotein and imaging features on gadoxetic acid-enhanced MRI.
Article in European radiology, 2024. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 10 papers.
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10 citing papers in PubMed, 12 citations in OpenAlex.
- 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
- [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
- Optimal Segment Selection on Gadoxetic Acid-Enhanced MRI to Improve Diagnostic Accuracy in the Histological Grading of Liver Inflammation and Fibrosis in Patients with Chronic Hepatitis B.Journal of clinical medicine · 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
- Predicting postresection outcomes in solitary small hepatocellular carcinoma via pretreatment MR imaging features: subgroup analysis according to alpha-fetoprotein expression.European radiology · 2025Article
- Long-term outcomes of indeterminate focal hepatic observations less than 20 mm followed up with gadoxetic acid-enhanced magnetic resonance imaging (Gd-EOB-DTPA-MRI).Journal of gastrointestinal oncology · 2025Article
- [New progress in the technology of non-invasive diagnosis for small hepatocellular carcinoma].Zhonghua gan zang bing za zhi = Zhonghua ganzangbing zazhi = Chinese journal of hepatology · 2025Review
- [Diagnosis and differential diagnosis of small hepatocellular carcinoma in the context of cirrhosis].Zhonghua gan zang bing za zhi = Zhonghua ganzangbing zazhi = Chinese journal of hepatology · 2025Article
- Hepatocellular Carcinoma: Imaging Advances in 2024 with a Focus on Magnetic Resonance Imaging.Current oncology (Toronto, Ont.) · 2025Review
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Abstract
objectiveTo investigate the role of serum alpha-fetoprotein (AFP) in diagnosing subcentimeter hepatocellular carcinoma (HCC) on gadoxetic acid-enhanced MRI (EOB-MRI).
methodsThis study retrospectively enrolled treatment-naïve patients with chronic hepatitis B who had a solitary subcentimeter observation on EOB-MRI from January 2017 to March 2023. Final diagnosis was confirmed by pathology for HCC and pathology or follow-up for benign controls. The AFP cutoff value for HCC was determined using Youden's index. Diagnostic criteria were developed according to significant findings in logistic regression analyses based on AFP and imaging features. The diagnostic performance of possible criteria was compared to the diagnostic hallmarks of HCC (arterial-phase hyperintensity and portal-phase hypointensity).
resultsA total of 305 patients (mean age, 51.5 ± 10.7 years; 153 men) were divided into derivation and temporal validation cohorts. Four findings, namely AFP >13.7 ng/mL, arterial-phase hyperintensity, portal-phase hypointensity, and transitional-phase hypointensity, were predictors of HCC. A new criterion (at least three of the four findings) showed higher sensitivity than the diagnostic hallmarks (derivation cohort, 71.6% vs. 52.3%, p < 0.001; validation cohort, 75.0% vs. 47.5%, p = 0.003) without decreasing specificity (derivation cohort, 92.5% vs. 92.5%, p > 0.999; validation cohort, 92.0% vs. 92.0%, p > 0.999). Another criterion (all four findings) achieved a slightly higher specificity than the diagnostic hallmark (derivation cohort, 99.1% vs. 92.5%, p = 0.023; validation cohort, 100.0% vs. 92.0%, p = 0.134). Subgroup analysis for hepatobiliary hypointense observations yielded similar results.
conclusionIncluding AFP in the diagnostic algorithm may improve the diagnostic performance for subcentimeter HCC. CLINICAL RELEVANCE STATEMENT: Combining imaging features on gadoxetic acid-enhanced MRI with alpha-fetoprotein may enhance the diagnostic performance for subcentimeter HCC in treatment-naïve patients with chronic hepatitis B. KEY POINTS: • The traditional diagnostic hallmark of HCC (arterial-phase hyperintensity and portal-phase hypointensity) shows modest diagnostic performance for subcentimeter HCC on EOB-MRI. • Serum alpha-fetoprotein > 13.7 ng/mL, arterial-phase hyperintensity, portal-phase hypointensity, and transitional-phase hypointensity were independent predictors for subcentimeter HCC. • A criterion of at least three of the four above findings achieved a higher sensitivity without decreasing specificity.
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