Added diagnostic value of T2-weighted MR imaging to gadolinium-enhanced three-dimensional dynamic MR imaging for the detection of small hepatocellular carcinomas

Purpose: To assess the added value of T2-weighted MRI to gadolinium-enhanced dynamic MRI for detection of HCCs. Materials and methods: Two readers retrospectively analyzed MRIs of 115 patients with 131 HCCs (size; 0.6-2.0 cm) that had been diagnosed by histology (n = 41) or imaging findings (n = 90). Two separate blind image analyses of the gadolinium set and the combined T2-weighted imaging and gadolinium sets were performed. Diagnostic accuracy was evaluated using the alternative-free response receiver operating characteristic method with four-point scale. Sensitivity and positive predictive value were also calculated. Results: For both observers, the Az values and sensitivities with the combined T2-weighed imaging and gadolinium set (mean Az 0.806, sensitivity 84.7) were significantly higher than those with the gadolinium set (mean Az 0.660, sensitivity 59.9) (p < 0.05). The addition of T2-weighted imaging led to a change in diagnosis for 27 lesions by both observers, which at gadolinium set were assigned a confidence level of 1 or 2 but at additional reading of T2-weighted imaging were assigned a confidence level of 3 or 4. For the positive predictive values, each image set showed a similar value for each observer. Conclusion: The addition of T2-weighted imaging to gadolinium-enhanced 3D dynamic imaging could be helpful in the detection of HCC by increasing reader confidence for HCCs with equivocal findings on gadolinium-enhanced MRIs.