Magnetic Resonance Widened Diagnostic Criteria for Hepatocellular Carcinoma

Luis Marti-Bonmati, Asunción Torregrosa, Vicente Navarro, Angel Rubin, Luis Bresó


Purpose: To assess the added value of specific MR imaging ancillary criteria used in a comprehensive radiological diagnostic guideline (Valencia multivariate classification, VLC-MV) for the non-invasive diagnosis of hepatocellular carcinoma (HCC).

Material and Methods: Descriptive observational retrospective study of 66 patients diagnosed with HCC. MR was performed on different 1.5 and 3T scanners. Standard gradient echo chemical shift T1-weighted, turbo-spin echo T2-weighted, diffusion-weighted with high b-values (800-1,000 s/mm²) and dynamic contrast-enhanced spoiled gradient echo T1-weighted (late arterial, portal and equilibrium phases) sequences were used. All cases were evaluated using the EASL-AASLD, LI-RADS and VLC-MV criteria. The VLC-MV classification developed in our center considers the added value of several different ancillary minor criteria (at least one vascular major criteria plus at least two minor criteria: capsule, fatty metamorphosis, mosaic pattern, signal changes on T1-weighted and T2-weighted sequences, restricted diffusion and vascular invasion) and does not include growth or size in order to minimise difficulties and biases. The VLC-MV criteria will be compared to the most widely used and established guidelines (EASL-AASL and LI-RADS).

Results: Mean HCC size was 38.6 ± 26 mm (standard deviation), range from 7 to 120 mm. There were 6 hypovascular tumours (9.1%) and 4 (6.1%) without wash-out. Regarding minor ancillary criteria, capsule was observed in 57 cases (86.4%), fatty metamorphosis in 11 (16.7%), T1-/T2 slight signal changes in 18 (27.3%), mosaic pattern in 5 (7.6%), diffusion hyperintensity in 45 (68.2%) and vascular invasion in 6 cases (9.1%). The VLC-MV was the most accurate classification (98.5% positive predictive value), followed by LI-RADS (84.8% for LI-RADS-5) and EASL-AASLD (80.3%), the differences being significant (Chi-Squared test, p=0.04 and 0.02).

Conclusions: MR imaging VLC-MV classification is a very accurate method for the non-invasive diagnosis of HCC, with the advantages of not requiring the evaluation of growth and not being limited by lesion size.


hepatocellular carcinoma; magnetic resonance imaging; diagnostic accuracy

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EASL-EORTC Clinical practice guidelines: Management of hepatocellular carcinoma. European association for the study of the liver, European Organization of Research and Treatment of Cancer. J Hepatol 2012; 56: 908-943.

Bruix J, Sherman M. American Association for the study of liver diseases (AASLD). Management of hepatocellular carcinoma: an update. Hepatology 2011; 53: 1020-1022.

Liver imaging reporting and data system (LI-RADS) 2014. American College of Radiology. http:

Aubé C, Oberti F, Lonjon J, et al. EASL and AASLD recommendations for the diagnosis of HCC to the test of daily practice. Liver Int 2017; 37(10): 1515-1525.

Cruite I, Tang A, Sirlin CB. Imaging-based diagnostic systems for hepatocellular carcinoma. AJR Am J Roentgenol 2013; 201: 41-55.

Lee YJ, Lee JM, Lee JS, et al. Hepatocellular carcinoma: diagnostic performance of multidetector CT and MR imaging-a systematic review and meta-analysis. Radiology 2015; 275: 97-109.

Chou R, Cuevas C, Fu R, et al. Imaging techniques for the diagnosis of hepatocellular carcinoma: a systematic review and meta-analysis. Ann Intern Med 2015; 162(10): 697-711.

Sangiovanni A, Manini MA, Iavarone M, et al. The diagnostic and economic impact of contrast imaging technique in the diagnosis of small hepatocellular carcinoma in cirrhosis. Gut 2010; 59: 638-644.

Darnell A, Forner A, Rimola J, et al. Liver imaging reporting and data system with MRimaging: Evaluation in nodules 20 mm or smaller detected in cirrhosis at screening US. Radiology 2015; 275: 698-707.

Park YN, Kim MJ. Hepatocarcinogenesis: imaging-pathologic correlation. Abdom Imaging 2011; 36: 232–243.

Kudo M. Multistep human hepatocarcinogenesis: correlation of imaging with pathology. J Gastroenterol 2009; 44 Suppl 19: 112-118.

Lee JM, Yoon JH, Kim KW. Diagnosis of hepatocellular carcinoma: newer radiological tools. Semin Oncol 2012; 39: 399-409.

Hennedige T, Venkatesh SK. Advances in computed tomography and magnetic resonance imaging of hepatocellular carcinoma. World J Gastroenterol 2016; 22: 205-220.

Quaia E, De Paoli L, Angileri R, et al. Evidence of diagnostic enhancement pattern in hepatocellular carcinoma nodules <2 cm according to the AASLD/EASL revised criteria. Abdom Imaging 2013; 38: 1245-1253.

Kierans AS, Kang SK, Rosenkrantz AB. The diagnostic performance of dynamic contrast-enhanced MR imaging for detection of small hepatocellular carcinoma measuring up to 2 cm: a meta- analysis. Radiology 2016; 278: 82-94.

Sersté T, Barrau V, Ozenne V, et al. Accuracy and disagreement of computed tomography and magnetic resonance imaging for the diagnosis of small hepatocellular carcinoma and dysplastic nodules: role of biopsy. Hepatology 2012; 55: 800-806.

Pahwa A, Beckett K, Channual S, et al. Efficacy of the American Association for the study of liver disease and Barcelona criteria for the diagnosis of hepatocellular carcinoma. Abdom Imaging 2014; 39: 753-760.

Kitao A, Matsui O, Yoneda N, et al. The uptake transporter OATP8 expression decreases during multistep hepatocarcinogenesis: correlation with gadoxetic acid enhanced MR imaging. Eur Radiol 2011; 21: 2056-2066.

Yoon JH, Park JW, Lee JM. Noninvasive diagnosis of hepatocellular carcinoma: elaboration on Korean liver cancer study Group-National Cancer Center Korea practice guidelines compared with other guidelines and remaining issues. Korean J Radiol 2016; 17: 7-24.

JSH Consensus-based clinical practice guidelines for the management of hepatocellular carcinoma: 2014 update by the liver cancer study group of Japan. Liver Cancer 2014; 3: 458-468.

Park MJ, Kim YK, Lee MW, et al. Small hepatocellular carcinomas: Improved sensitivity by combining gadoxetic acid–enhanced and diffusion-weighted MR imaging patterns. Radiology 2012; 264: 761-770.

Rimola J, Forner A, Tremosini S, et al. Non-invasive diagnosis of hepatocellular carcinoma ≤ 2 cm in cirrhosis. Diagnostic accuracy assessing fat, capsule and signal intensity at dynamic MRI. J Hepatol 2012; 56: 1317-1323.



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