• Emilio Quaia, Luca De Paoli, Roberta Angileri, Riccardo Pizzolato, Biagio Cabibbo, and Maria Assunta Cova.
• Department of Radiology, Cattinara Hospital, University of Trieste, Strada di Fiume 447, 34149, Trieste, Italy, quaia@units.it.
• Abdom Imaging. 2013 Dec 1; 38 (6): 1245-53.

PurposeTo define the percentage of small (≤2 cm) hepatocellular carcinoma (HCC) nodules showing the diagnostic enhancement pattern at CEUS, computed tomography (CT), and gadobenate dimeglumine (Gd-BOPTA)-enhanced magnetic resonance (MR) imaging.Methods42 cirrhotic patients (26 male, 16 female; 67 ± 12 years) with 46 biopsy-proven HCCs ≤2 cm were included. Each HCC was scanned by CEUS, contrast-enhanced CT, and Gd-BOPTA-enhanced MR imaging. Nodule enhancement was evaluated by two readers. Independent analysis was followed by consensual analysis and the proportion of HCCs with the diagnostic enhancement pattern (nodule hyperenhancing on hepatic arterial phase and hypoenhancing on portal venous-late phase) on CEUS, CT, and MR imaging was compared by chi-square test.ResultsVery good inter-reader agreement was observed on hepatic arterial phase and portal venous-late phase: CEUS, k = 0.89 and 0.85; CT, k = 0.91 and 0.88; MR imaging, k = 0.96 and 0.94. CEUS and CT did not differ in the percentage of HCC nodules with a diagnostic enhancement pattern (18/46 and 16/46; P = 0.66), while MR imaging revealed the diagnostic pattern in higher percentage of nodules (29/46; P = 0.012) in comparison to CEUS and CT.ConclusionsCEUS and contrast-enhanced CT did not differ in the percentage of small HCC nodules with diagnostic enhancement pattern, while Gd-BOPTA-enhanced MR imaging revealed the diagnostic pattern in a higher nodule number in comparison to CEUS and CT.

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