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Purpose: To investigate whether an isotropic T1-weighted gradient echo (T1-GRE) sequence using a compressed sensing (CS) technique during liver magnetic resonance imaging (MRI) can improve the image quality compared to that using a standard parallel imaging (PI) technique in patients with hepatocellular carcinoma (HCC)., Methods: Forty-nine patients with single pathologically confirmed HCC were included in the prospective study, who underwent a 3.0 T MRI including the two T1-GRE sequences (CS and PI). Qualitative analysis including the relative contrast (RC) of liver-to-lesion, liver-to-portal vein and liver-to-hepatic vein on pre-contrast and postcontrast (delayed phase) images were calculated. Respiratory motion artifact, gastrointestinal motion artifact and overall image quality were scored by using a 4-point scale., Results: RC of liver-to-lesion, liver-to-portal vein and liver-to-hepatic vein measured on both pre-contrast and postcontrast phase images were significantly higher for CS than for PI. The scores of overall image quality was comparable between PI and CS (3.98 ± 0.10vs 3.96 ± 0.13, P = 0.083 for pre-contrast; 3.96 ± 0.16 vs 3.93 ± 0.17, P = 0.132 for postcontrast, respectively). The scores of gastrointestinal motion artifact was significantly higher for PI than for CS (3.92 ± 0.21 vs 3.69 ± 0.33 for pre-contrast; 3.86 ± 0.21 vs 3.59 ± 0.30 for postcontrast, P < 0.001 for both). The scores of respiratory motion artifact was significantly higher for PI only in pre-contrast sequence (3.97±0.11 vs 3.89 ± 0.22, P = 0.002 for pre-contrast; 3.95 ± 0.18 vs 3.90 ± 0.22, P = 0.083 for postcontrast, respectively)., Conclusions: Compared to the standard PI sequence, the CS technique can provide greater contrast in displaying HCCs and hepatic vessels in MRI without compromise of overall image quality., (Copyright © 2021 Elsevier B.V. All rights reserved.)

Purpose: To determine the feasibility of pre-TACE IVIM imaging based on histogram analysis for predicting prognosis in the treatment of unresectable hepatocellular carcinoma (HCC)., Materials and Methods: Fifty-five patients prospectively underwent 1.5T MRI 1 week before TACE. Histogram metrics for IVIM parameters and ADCs maps between responders and non-responders with mRECIST assessment were compared. Kaplan-Meier, log-rank tests and Cox proportional hazard regression model were used to correlate variables with time to progression (TTP)., Results: Mean (p = 0.022), median (p = 0.043), and 25 th percentile (p < 0.001) of perfusion fraction (PF), mean (p < 0.001), median (p < 0.001), 25 th percentile (p < 0.001) and 75 th percentile (p = 0.001) of ADC (0,500) , mean (p = 0.005), median (p = 0.008) and 25 th percentile (p = 0.039) of ADC total were higher, while skewness and kurtosis of PF (p = 0.001, p = 0.005, respectively), kurtosis of ADC (0,500) and ADC total (p = 0.005, p = 0.001, respectively) were lower in responders compared to non-responders. Multivariable analysis demonstrated that mRECIST was associated with TTP independently, and kurtosis of ADC total had the best predictive performance for disease progression., Conclusion: Pre-TACE kurtosis of ADC total is the best independent predictor for TTP., Key Points: • mRECIST was associated with TTP independently. • Lower kurtosis and higher mean for ADCs tend to have good response. • Pre-TACE kurtosis of ADC total is the best independent predictor for TTP.

Purpose: The goal of this study was to investigate the Liver Imaging Reporting and Data System (LI-RADS) v.2017 for the categorization of hepatocellular carcinomas (HCCs) with gadoxetic acid compared with gadopentetate dimeglumine-enhanced 1.5-T magnetic resonance imaging (MRI)., Material and Methods: We included 141 high-risk patients with 145 pathologically-confirmed HCCs who first underwent gadopentetate dimeglumine-enhanced 1.5-T followed by gadoxetic acid-enhanced 1.5-T MRI. Two independent radiologists evaluated the presence or absence of major HCC features and assigned LI-RADS categories after considering ancillary features on both MRIs. Finally, the sensitivity of LI-RADS category 5 (LR-5) and the frequencies of major HCC features were compared between gadoxetic acid- and gadopentetate dimeglumine-enhanced 1.5-T MRI using the Wilcoxon test., Results: The sensitivity of LR-5 for diagnosing HCCs was significantly different between gadoxetic acid- and gadopentetate dimeglumine-enhanced MRI (73.8% [107/145] vs 26.2% [38/145], P < 0.001; 71% [103/145] vs 29% [42/145], P < 0.001 for reviewers 1 and 2, respectively). Among the major HCC LI-RADS features, capsule appearance was less frequently demonstrated on gadoxetic acid-enhanced MRI than on gadopentetate dimeglumine-enhanced MRI (3.4% [5/145] vs 5.5% [8/145], P = 0.793; 4.1% [6/145] vs 5.5% [8/145], P = 0.87 for reviewers 1 and 2, respectively), and the frequency of arterial hyperenhancement was not significantly different between gadoxetic acid and gadopentetate dimeglumine (89% [129/145] vs 89% [129/145], P = 1.000). In addition, the frequency of a washout appearance was less in the transitional phase (TP) than in the portal venous phase (PVP) on gadoxetic acid-enhanced MRI (43% [46/107] vs 57% [61/107], P = 0.367)., Conclusion: Gadoxetic acid-enhanced MRI showed a comparable sensitivity to gadopentetate dimeglumine-enhanced MRI for the diagnosis of HCCs, and LI-RADS category 4 (LR-4) hepatic nodules were upgraded to LR-5 when taking into account the major features according to LI-RADS v.2017.

Purpose: Our purpose was to demonstrate the prognostic significance of T 1 mapping on gadoxetic acid-enhanced MR imaging in prediction of recurrence of single HCC after hepatectomy., Materials and Methods: One hundred and seven patients with single nodular HCC (≤3 cm) who underwent preoperative gadoxetic acid-enhanced MRI were included in the study. T 1 mapping with syngo MapIt was obtained on a 1.5 T scanner. Radiological features and reduction rate of T 1 relaxation time (Δ%) of tumors were assessed by two radiologists. Cumulative recurrence rates were compared between groups of low and high reduction rate of T 1 relaxation time. A further classified cumulative recurrence rate of the overall cohort was based on the numbers of independent predictive factors., Results: Reduction rate of T 1 relaxation time (P = 0.001) and non-hypervascular hypointense nodules (P = 0.042) in preoperative gadoxetic acid-enhanced MRI were independently related to recurrence of HCC after hepatectomy. Patients of lower reduction rates group had higher cumulative recurrence rates (P < 0.0001) than patients of higher reduction rates group. A combination of the two risk factors in patients with single HCC had significantly higher recurrence rates compared to those with either or none of the two risk factors., Conclusions: Reduction rate of T 1 relaxation time combined with non-hypervascular hypointense nodules can be reliable biomarkers in the preoperative prediction of recurrence of HCC after hepatectomy., (Copyright © 2018 Elsevier B.V. All rights reserved.)

Purpose: To compare MR imaging features of combined hepatocellular-cholangiocarcinoma (cHCC-CC) in normal, fibrotic, and cirrhotic livers., Methods: A total of 64 patients with 67 pathologically proven cHCC-CCs were retrospectively analyzed. Patients were classified into three groups according to the patients' liver condition: patients with normal liver (F0, group 1), fibrosis without cirrhosis (F1-3, group 2), and cirrhosis (F4, group 3). The morphological and MR signal features on T1- and T2-weighted, dynamic contrast-enhanced, diffusion-weighted imaging, as well as the accompanying imaging findings, were evaluated and compared., Results: There were 12, 19, and 33 patients in groups 1, 2, and 3, respectively. Tumors in the fibrotic and cirrhotic livers were smaller than those in the normal liver, and tumors with cirrhosis had the smallest size (P = 0.0326). No statistical difference was found when comparing the signal intensity on T2-weighted imaging (P = 0.496), but iso- or hypointense lesions were only found in the fibrosis (n = 2) or cirrhosis group (n = 2). Enhancement pattern was different between groups, the washout pattern was more often seen in the cirrhosis group (P = 0.049), and the accompanying mosaic architecture was also more commonly seen in the cirrhosis group (P = 0.048). The ADC values of the lesions were not different among the three groups (P = 0.899)., Conclusion: MRI may provide valuable information for the diagnosis and differential diagnosis of cHCC-CC in normal, fibrotic, and cirrhotic livers. The nodule size, enhancement pattern, and the presence of mosaic architecture in cHCC-CC differ between different degrees of background liver disease.

Background: Radiofrequency ablation (RFA) is related to a high intrahepatic distant recurrence (IDR) rate, and the associations between IDR and relevant imaging features have not yet been fully investigated. This study aimed to determine both clinical and imaging risk factors of IDR after complete RFA for HBV-related small hepatocellular carcinoma (HCC) (≤ 3 cm)., Methods: Thirty-five patients (29 men and 6 women; mean age 60.7 years) with 40 HBV-related small HCCs who underwent complete RFA were included in our study. The incidence and potential clinical and MR imaging risk factors for IDR after RFA were assessed using the Kaplan-Meier method, the log-rank test and a stepwise Cox hazard model., Results: The median follow-up period was 25 (4-45) months, and IDR was observed in 20 (57.1%) patients. The 12- and 24-month cumulative IDR-free survival rates were 76.7% and 61.3%, respectively. Univariate analysis revealed that pretreatment albumin < 3.5 g/dL (P = 0.026), multinodular tumor (P = 0.032), ablative margin < 3 mm (P = 0.007), no or disrupted periablational enhancement within 24 hours (P = 0.001) and at 1 month (P = 0.043) after RFA, and hyperintensity of the central ablative zone on T1-weighted images (T1WI) at 1 month after RFA (P = 0.004) were related to IDR. Multivariate analysis showed that pretreatment albumin < 3.5 g/dL (P = 0.032), multinodular tumor (P = 0.012), no or disrupted periablational enhancement within 24 hours after RFA (P = 0.001), and hyperintensity of the central ablative zone on T1WI at 1 month after RFA (P = 0.003) were independent risk factors for IDR. During the 1-month follow-up, the apparent diffusion coefficient exhibited an up-and-down evolution without significant value in the prediction of IDR following RFA., Conclusions: Patients with HBV-related small HCC had a high IDR rate after RFA. The risk factors included low serum albumin, multiple nodules, lesions with no or disrupted periablational enhancement and persistent hyperintensity in the central ablative zone on T1WI within 1 month after RFA.

Purpose: The objective of this study is to compare MR imaging features of small hepatocellular carcinoma (HCC) (≤ 2 cm) in normal, fibrotic, and cirrhotic liver., Methods: A total of 215 patients with 235 pathologically proven sHCC were retrospectively analyzed. Patients were classified into three groups according to the patients' liver condition: patients with normal liver (F0, group 1), fibrosis without cirrhosis (F1-3, group 2), and cirrhosis (F4, group 3). The morphological and MR signal features on T1, T2-weighted, dynamic enhanced, and diffusion-weighted imaging were evaluated and compared., Results: There were 10, 38, and 167 patients in group 1, 2, and 3, respectively. Patients with normal liver were older than those with fibrosis or cirrhosis (P = 0.0086), and tumors in the normal liver were larger than those in the fibrotic or cirrhotic liver (P = 0.0407). No statistical differences were found among groups in signals on T2-weighted images (P = 0.163), signals on each phase after contrast (P = 0.269, 0.893, and 0.259, respectively), enhancement patterns (P = 0.753), ADC values (P = 0.760), as well as the presence of capsule-like enhancement (P = 0.953), mosaic pattern (P = 0.572), fat content (P = 0.222), iron sparing (P = 1.000), hemorrhage (P = 0.181), and venous invasion (P = 0.175). Both signal-to-noise ratios (SNR) (χ (2) = 2.045, P = 0.132) and lesion-to-liver contrast-to-noise ratios (CNR) (χ (2) = 0.438, P = 0.646) were not different as well. But confusing features of iso/hypointensity on T2-weighted imaging (n = 11, 6.0%) and progressive enhancement pattern (n = 2, 1.1%) were exclusively found in the cirrhosis background, and hypovascular tumors with iso/hypointensity on arterial phase were only seen in the fibrosis (n = 5, 11.9%) and cirrhosis groups (n = 10, 5.5%)., Conclusion: MR features of sHCC were similar among patients with normal, fibrotic, and cirrhotic livers.

Aim: To compare differences between volumetric interpolated breath-hold examination (VIBE) using two-point Dixon fat-water separation (Dixon-VIBE) and chemically selective fat saturation (FS-VIBE) with magnetic resonance imaging examination., Methods: Forty-nine patients were included, who were scanned with two VIBE sequences (Dixon-VIBE and FS-VIBE) in hepatobiliary phase after gadoxetic acid administration. Subjective evaluations including sharpness of tumor, sharpness of vessels, strength and homogeneity of fat suppression, and artifacts that were scored using a 4-point scale. The liver-to-lesion contrast was also calculated and compared., Results: Dixon-VIBE with water reconstruction had significantly higher subjective scores than FS-VIBE in strength and homogeneity of fat suppression (< 0.0001) but lower scores in sharpness of tumor (P < 0.0001), sharpness of vessels (P = 0.0001), and artifacts (P = 0.034). The liver-to-lesion contrast on Dixon-VIBE images was significantly lower than that on FS-VIBE (16.6% ± 9.4% vs 23.9% ± 12.1%, P = 0.0001)., Conclusion: Dixon-VIBE provides stronger and more homogenous fat suppression than FS-VIBE, while has lower clarity of focal liver lesions in hepatobiliary phase after gadoxetic acid administration.

Purpose: To investigate MR imaging findings of primary hepatic neuroendocrine carcinoma (PHNEC) including preliminary observations on diffusion-weighted imaging (DWI)., Materials and Methods: MR images of eight patients with pathologically confirmed PHNEC were retrospectively analyzed. The morphological characteristics and dynamic enhancement patterns were evaluated., Results: One case showed a well-defined solitary nodule with homogenous hypointensity on T1-weighted imaging (T1WI) and hyperintensity on T2-weighted imaging (T2WI) and DWI. The remaining seven cases appeared as well-defined dominant masses with multiple satellite nodules. The dominant masses demonstrated heterogeneous hypointensity on T1WI and hyperintensity on T2WI, which all appeared as a marked enhancement at arterial phase and rapid washout at portal venous phase. Six cases demonstrated rim-like enhancement at equilibrium phase. The satellite lesions showed heterogeneous hypointensity on T1WI and marked hyperintensity on T2WI with variable enhancements, such as homogeneous, rim-like enhancement. All the dominant masses and satellite nodules appeared as markedly hyperintensity and reduced apparent coefficient (ADCs) values on DWI. The mean ADC value of the tumors was significantly lower than that of surrounding liver parenchyma (1.02 ± 0.57 vs. 2.24 × 10(-3) mm(2)/s, p = 0.000)., Conclusion: PHNECs typically appear as a large dominant hypervascular mass accompanied by satellite nodules, with rapid washout and capsular enhancement on dynamic MR imaging and restricted diffusion on DWI.

Background: Three-dimensional (3D) whole-liver perfusion magnetic resonance (MR) imaging with parallel imaging, a novel imaging method to characterize tumor vascularization in vivo, has recently been applied to comprehensively image perfusion changes in large tumors. Coupled with new perfusion software, this technique enables motion correction, registration, and evaluation of perfusion MR parameters. The purpose of this study was to assess the feasibility of 3D whole-liver perfusion MR, for imaging hepatocellular carcinoma (HCC) and colorectal hepatic metastases (CRHM)., Methods: 26 patients with hepatic tumors (10 HCC; 16 CRHM) were subjected to 3D whole-liver perfusion MR with a temporal resolution of 3.7 seconds. The following estimated perfusion parameters were measured: the volume transfer constant K(trans) (min(-1)); the volume (V(e)) of extravascular extracellular space (EES) per volume unit of tissue; and the flux rate constant between EES and plasma K(ep) (min(-1)). Statistical analysis was conducted to investigate inter-observer characteristics and significance of the measured parameters., Results: Inter-observer agreement analysis (95% limits of agreement) yielded a mean difference of -0.0048 min(-1) (-0.0598 ~ 0.0502) for K(trans), -0.0630 ml (-0.5405 ~ 0.4145) for V(e), and -0.0031 min(-1) (-0.0771 ~ 0.0709) for K(ep) respectively. When comparing images from patients with HCC vs. CRHM, significant differences were seen for the mean K(trans) (p = 0.017), but not for V(e) (p = 0.117) or K(ep) (p = 0.595)., Conclusion: Herein we show that 3D whole-liver MR perfusion imaging with semi-automatic data analysis is feasible and enables the reliable quantitative evaluation of the perfusion parameters for HCCs and CRHMs.

Purpose: To assess the value of 2D multibreath-hold susceptibility-weighted imaging (SWI) for visualizing intratumoral hemorrhage of hepatocellular carcinoma (HCC) and correlate with pathological results., Materials and Methods: Fifty-eight patients with 65 HCCs underwent T1-, T2-, T2-weighted imaging and SWI. The ability to detect intratumoral hemorrhage for each imaging technique was evaluated. A radiologic-pathological correlation was performed., Results: The area under the receiver operator characteristic (ROC) curve (Az value) for SWI (Az = 0.941) was significantly greater than that for T1WI (Az = 0.748) and T2WI (Az = 0.700) (P = 0.000). When compared with T2, SWI had slightly higher sensitivity and equal specificity, but the Az value was not significantly different (P = 0.768). The total number of hemorrhages detected by SWI was greatest by factors of 13.3, 6.7, and 2.2 compared to T1WI, T2WI, and T2, respectively. SWI detected more microbleeds (585 in 25 HCCs) than T1WI (13 in 5 HCCs), T2WI (66 in 11 HCCs), and T2 (238 in 21 HCCs)., Conclusion: SWI can accurately visualize internal hemorrhages and provide valuable information regarding the internal architecture of HCC., (Copyright © 2012 Wiley Periodicals, Inc.)

Objectives: To evaluate the diagnostic value of diffusion-weighted magnetic resonance imaging (DWI) for the characterization of hepatocellular carcinoma (HCC) and dysplastic nodule (DN) in cirrhotic liver, compared with contrast material-enhanced magnetic resonance imaging (CE-MRI)., Methods: A total of 54 patients with 40 HCC and 19 DN lesions were included in our study, and all lesions were histopathologically confirmed. All lesions were evaluated with CE-MRI, and breath-hold DWI was performed with b = 500 s/mm. The signal intensity (SI) of the lesions were classified as low, iso-, slightly high, and strongly high SI compared with that of the surrounding liver parenchyma on DWI for qualitative assessment. Apparent diffusion coefficients (ADCs) and lesion-to-liver ADC ratio of HCCs and DNs were measured and compared by using the Mann-Whitney U test. The lesions were characterized with the use of CE-MRI criteria and DWI, respectively. Receiver operating characteristic analysis was performed to assess the diagnostic value of DWI, CE-MRI, and these techniques combined in the differentiation of HCCs from DNs., Results: In the qualitative analysis, among 40 HCCs, 39 (97.5%) had slightly high or strongly high SI on DWI, and 1 (2.5%) had low SI; only 4 (21.5%) of 19 DNs had slightly high SI, and 15 (78.95%) had iso-SI or low SI. The mean (SD) ADC and ADC ratio for HCCs (1.28 x 10 [0.25] mm/s and 0.88 [0.15], respectively) were significantly lower (P < 0.01 and P < 0.001, respectively) than those for DNs (1.53 x 10 [0.33] mm/s and 1.00 [0.08], respectively). The area, Az, under the receiver operating characteristic curve for the SI feature, the ADC ratio, and the ADCs based on the diagnosis of HCC versus DN were 0.88, 0.81, and 0.68, respectively. When the slightly high SI of lesion with a cutoff ADC ratio less than 0.92 was applied as a criterion, the Az, the sensitivity, the specificity, and the accuracy of DWI for the diagnosis of HCC versus DN were 0.81, 67.50%, 94.74%, and 76.27%, respectively. The corresponding Az, sensitivity, specificity, and accuracy of CE-MRI were 0.70, 82.50%, 57.89%, and 74.58%, respectively. Combined DWI plus CE-MRI had 0.91 Az, 97.50% sensitivity, and 93.22% accuracy, which increased significantly compared with those of CE-MRI alone., Conclusions: Diffusion-weighted MRI can provide additional information to differentiate HCC from DN. Combined with CE-MRI, DWI allows improved characterization of HCC versus DN in cirrhotic liver.

Objective: To evaluate the added value of single breath-hold diffusion-weighted imaging (DWI) in detection of small HCC lesions (

Aim: To evaluate the efficacy of ferucarbotran-enhanced MR imaging in the detection of focal hepatic lesions compared to plain and Gd-DTPA-enhanced MR imaging., Methods: Fifty-nine patients with suspected focal hepatic lesions were admitted to the study. Plain MR imaging (FSE T(2)WI with fat suppression and GRE T(1)WI sequences) and Gd-DTPA dynamic enhanced MR of the liver were initially performed followed by ferucarbotran-enhanced MR imaging 48 h later (including GRE T(1)WI, FSE T(2)WI with fat suppression, and GRE T(2)WI sequences). Images were reviewed independently by three observers. Results were correlated with surgery and pathologic examination or reference examination, and sensitivity was statistically calculated for the different MR imaging sequences., Results: Among all confirmed lesions (n = 133), ferucarbotran-enhanced MR imaging revealed 130 lesions on FSE T(2)WI with fat suppression, 115 lesions on dynamic T(1)WI GRE, and 127 lesions on GRE T(2)WI. Pre-contrast MR imaging revealed only 84 lesions on GRE T(1)WI and 106 lesions on FSE T(2)WI with fat suppression, while Gd-DTPA dynamic enhanced GRE T(1)WI revealed 123 lesions. For 44 micro-lesions (< 1.0 cm) in all patients the detection rates were as follows: ferucarbotran-enhanced FSE T(2)WI with fat suppression, 93.2% (41/44); ferucarbotran-enhanced GRE T(2)WI, 88.6% (39/44); Gd-DTPA dynamic-enhanced GRE T(1)WI, 79.5% (35/44); pre-contrast FSE T(2)WI with fat suppression, 54.5% (24/44); and pre-contrast GRE T(1)WI, 34.1% (15/44). In detecting micro-lesions, statistically significant difference was found for Ferucarbotran-enhanced FSE T(2)WI with fat suppression and GRE T(2)WI sequences compared to the other sequences (P < 0.05)., Conclusion: Ferucarbotran-enhanced FSE T(2)WI with fat suppression and GRE T(2)WI sequences are superior in detecting micro-lesions (< 1 cm) in comparison with plain and Gd-DTPA dynamic-enhanced MR imaging.

Aim: To evaluate the value of superparamagnetic iron oxide (SPIO) enhanced MRI in characterizing focal hepatic lesions., Methods: Forty-three patients (32 men,11 women, mean age 51 years, age range 25-74 years) with previously identified focal hepatic lesions were enrolled into this study. All the patients underwent plain, Gd-DTPA enhanced MRI and the SPIO enhanced MRI 1-7 d later. The surgico-pathologic diagnosis was aestablished in 31 cases and the diagnosis in other 12 cases was made on the basis of clinical findings and biochemical tests. The signal changes of lesions were analyzed and the CNRs of lesion-to-liver were measured before and after SPIO enhancement. The data were analyzed by paired t test., Results: Focal hepatic lesions included primary hepatocellular carcinoma (HCC,n=22), hemangioma (n=5), cyst (n=4), metastases (n=5), cirrhotic nodule (n=4), focal nodular hyperplasia (FNH, n=5) and other miscellaneous lesions (n=6). After SPIO enhancement HCC demonstrated iso- or slight hyperintensity on T1WI and moderate hyperintersity on T2WI, hemangioma showed moderate hyperintensity on T1WI and obvious hyperintensity on T2WI, the SI of cyst had no change either on T1WI or on T2WI, cirrhotic nodules revealed iso-intensity on T2WI, and the SI of FNH decreased significantly on T2WI. No specific manifestations were found in the other 6 miscellaneous lesions after SPIO enhancement., Conclusion: SPIO enhanced-MRI can improve the characterization confidence for diagnosis of focal hepatic lesions.