• Rita Golfieri, Luigi Grazioli, Emanuela Orlando, Ada Dormi, Vincenzo Lucidi, Beniamino Corcioni, Ernesto Dettori, Laura Romanini, and Matteo Renzulli.
• Radiology Unit, Department of Digestive Diseases and Internal Medicine; Sant'Orsola-Malpighi Hospital, University of Bologna, Via Albertoni 15, Bologna, Italy.
• J Magn Reson Imaging. 2012 Sep 1; 36 (3): 648-57.

PurposeTo investigate whether the malignancy of atypical nodules in cirrhosis can be identified at gadoxetic-acid-disodium(Gd-EOB-DTPA)-MRI by their hypointensity in the hepatobiliary(HB)-phase alone or combined with any other MR imaging features.Materials And MethodsOne hundred eleven atypical nodules detected in 77 consecutive Gd-EOB-DTPA-MRIs were divided, based on arterial-phase behavior, into: Class I, isovascular (n = 82), and Class II, hypervascular without portal/delayed washout (n = 29). The two classes were further grouped based on HB-phase intensity (A/B/C hypo/iso/hyperintensity). Portal/venous/equilibrium-phase behavior and T2w features were also collected. Histology was the gold standard. Per-nodule sensitivity, specificity, negative and positive predictive values (NPV/PPV), and diagnostic accuracy were calculated for HB-phase hypointensity alone, and combined with vascular patterns and T2w hyperintensity.ResultsHistology detected 60 benign and 51 malignant/premalignant nodules [10 overt hepatocellular carcinomas (HCCs) and 41 high-grade dysplastic nodules (HGDN)/early HCC]. Class IA contained 31 (94%) malignancies, IB one (3%), and IC only benign lesions. Class IIA had 100% malignancies, IIB three (37.5%) and IIC only two (28.5%). HB-phase hypointensity alone (Classes I-IIA) had 88% sensitivity, 91% NPV, and 93% diagnostic accuracy, superior (P < 0.05, P < 0.006, and P < 0.05, respectively) to any other MR imaging feature alone or combined.ConclusionIn atypical cirrhotic nodules, HB-phase hypointensity by itself is the strongest marker of malignancy.Copyright © 2012 Wiley Periodicals, Inc.

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