Source Radiology Department. Barcelona Clinic Liver Cancer (BCLC) group. Hospital Clinic Barcelona. IDIBAPS. University of Barcelona, Spain; Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBERehd).

BACKGROUND AND AIMS: To prospectively assess the diagnostic accuracy of the incorporation of additional MRI parameters to those based on contrast enhancement pattern for the diagnosis of solitary nodules between 5-20 mm detected during surveillance in patients with cirrhosis.

METHODS: Between November 2003 and January 2010 we prospectively included 159 cirrhotic patients with a newly detected solitary nodule between 5-20 mm in diameter by screening US. Hepatic MRI and fine-needle biopsy were performed in all patients.

RESULTS: Final diagnoses were: Hepatocellular carcinoma (HCC) (n=103), other malignant lesions (intrahepatic cholangiocarcinoma/metastases) (n=4), and benign lesions (n=52). The specific enhancement pattern (arterial enhancement followed by washout) yielded a sensitivity and specificity of 58.2 and 96.4%, respectively. Capsule was present in 45 HCC and in 2 non-HCC lesions. Intralesional fat was detected in 24 nodules; 5 nodules were non-HCC. Finally, the presence of capsule and fat was present in 10 cases, all of them HCC (100% specificity), but all of them also displayed the specific enhancement pattern, thus adding no sensitivity or specificity.

CONCLUSIONS: Conclusive non-invasive diagnosis of HCC in cirrhosis should be based only in the contrast enhancement pattern, while other characteristics at MRI do not increase the diagnostic accuracy.