Small Hepatocellular Carcinoma and Dysplastic Nodules in Cirrhotic Livers: Differentiation with Dynamic MR Imaging

Abstract

Objective: To evaluate the usefulness of spin-echo T2
and T1-weighted images and contrast-enhanced
dynamic gradient-echo images in differentiating
between hepatocellular carcinoma and dysplastic
nodules in cirrhotic livers.
Method:  Thirty-eight patients with liver cirrhosis
underwent  spin-echo T2 and T1-weighted and
contrast-enhanced dynamic gradient-echo imaging. 16
small hepatocellular carcinomas (< 3 cm) in 16 patients
and 12 dysplastic nodules (> 1 cm) in 12 patients were
included in this study. Spin-echo sequences and
dynamic examination were compared for
characterisation of liver lesions.
Results: On combined SE T2 and T1-weighted images
and dynamic MR images, the most common
appearances were hyperintensity on T2-weighted
images (63%), hyperintensity on T1-weighted images
(50%) and hypervascularity (88%) for hepatocellular
carcinomas. All of the dysplastic nodules were
isointense on T2-weighted images and  except one, all
dysplastic nodules enhanced similar to the liver
parenchyma.
Conclusion: In the differential diagnosis of focal lesions
in cirrhotic liver, contrast enhancement features are
as diagnostic as the signal intensity of the lesions on
spin-echo sequences. Hyperintensity on T2-weighted
images and hypervascularity on dynamic contrast-enhanced MR imaging are statistically significant
features of HCCs developing in cirrhotic livers.
Key words: Cirrhosis, MR, liver neoplasms, diagnosis

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