MRI in the differential diagnosis between well-differentiated hepatocellular carcinomas and high-grade dysplastic nodules in cirrhotic liver

Abstract Objective To assess the diagnostic efficacy of magnetic resonance imaging (MRI) in the differential diagnosis between well-differentiated hepatocellular carcinomas (WD-HCCs) and high-grade dysplastic nodules (HGDNs) in cirrhotic liver. Material and methods From January 2012 to April 2018, we retrospectively analyzed 91 cirrhotic nodules (HGDN, n=31, WD-HCC, n=60) which were confirmed by surgery or pathology. Each patient underwent gadobenate dimeglumine-enhanced hepatic MRI. The MRI characteristics and enhancement effects were calculated and analyzed. Results Hyperintensity on diffusion-weighted imaging (DWI), the typical enhancement pattern and hypo-intensity on T1-Weighted imaging (T1WI)were showed with statistically significant difference between WD-HCCs and HGDNs in cirrhotic live (P=0.002, 0.008, 0.002, respectively). And high signal intensity (SI) on DWI (sensitivity, 66.7%, specificity, 67.7%) was the most specific feature to differentiated WD-HCCs from HGDNs. The combination of DWI and the dynamic enhancement pattern improved the differentiation of WD-HCCs from HGDNs(specificity 83.9%). Conclusion DWI is the most specific technique to differentiate WD-HCCs from HGDNs. The combination of DWI and the typical dynamic enhancement pattern can improve the differentiation of WD-HCCs from HGDNs. Pre-enhanced T1WI, as well as a capsule, provides additional diagnostic values.