Non-contrast Magnetic Resonance Imaging versus the Multiphase Computed Tomography with Respect to the Asia–Pacific Clinical Practice Guidelines: A Diagnostic Performance Study for Liver Cancer

Özet

Background: Guidelines recommend multiphasic computed tomography (CT) and/or contrast-enhanced magnetic resonance imaging (MRI) for the detection of hepatocellular carcinoma. The objectives of the study were to compare diagnostic parameters of non-contrast MRI against multiphase CT for diagnostic of hepatocellular carcinoma in patients who at risk of liver cancer considering Asia–Pacific clinical practice guidelines as the reference standard. Methods: Medical records of patients with chronic hepatic disease or have suspected liver cancer in surveillance of fewer than 100 days and underwent multiphasic CT, gadoxetic acid-enhanced MRI, and liver biopsy for diagnosis of liver cancer were included in analysis. Enhancement during the arterial phase and wash-out during a delayed phase or portal-venous considered as hepatocellular carcinoma in the multiphase CT. Mild-to-moderate hypersensitivity in imaging, presence of fat on out-of-phase imaging, non-enhancing capsule(s), mosaic appearance, hemorrhagic content, and/or nodule-in-nodule considered as hepatocellular carcinoma in MRI. Asia– Pacific clinical practice guidelines considered for biopsy/histopathology for detection of hepatocellular carcinoma. Results: For detection of hepatocellular carcinoma, non-contrast MRI had higher sensitivity (0.843 vs. 0.762, P < .001, q=3.919) and accuracy (0.755 vs. 0.571, P < .001, q=3.362) than the multiphase CT. While specificity was the same (0.864 vs. 0.809, P < .001, q=2.584). Non-contrast MRI had 0-0.91 diagnostic confidence and multiphase CT had 0.49-0.81 diagnostic confidence for the detection of hepatocellular carcinoma. Conclusions: Non-contrast MRI easily facilitates the decision of chemotherapy and/or radiotherapy than multiphase CT in hepatocellular carcinoma.