• Seung Soo Kim, Seong Hyun Kim, Kyoung Doo Song, Seo-Youn Choi, and Nam Hun Heo.
• Department of Radiology and Center for Imaging Science, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea.
• J Magn Reson Imaging. 2020 Jan 1; 51 (1): 70-80.

BackgroundHypervascular hyperplastic nodules (HHNs) occasionally develop in patients with alcoholic liver cirrhosis (ALC) and show arterial enhancement, thus mimicking hepatocellular carcinoma (HCC). Importantly, HHN as a benign lesion should be distinguished from HCC.PurposeTo evaluate the value of gadoxetic acid-enhanced MRI (Gd-EOB-MRI) and diffusion-weighted imaging (DWI) in distinguishing HHN from small (<3 cm) hypervascular HCC (hHCC) in patients with ALC.Study TypeRetrospective case-control study.Field Strength/Sequence3.0T/in- and out-of-phase, T1 -weighted, T2 -weighted, diffusion-weighted, apparent diffusion coefficient, and dynamic gadoxetic acid-enhanced images.PopulationAmong 560 patients with ALC who underwent Gd-EOB-MRI and DWI, 12 patients with 28 HHNs and 22 patients with 29 hHCCs smaller than 3 cm were included.AssessmentThe following MRI features were evaluated by three independent radiologists: signal intensity (SI) on T1 -weighted, T2 -weighted, diffusion-weighted, and hepatobiliary phase (HBP) images; shape, homogeneity, and margin on HBP; diffusion restriction; intralesional fat; necrosis; hemorrhage; washout on portal venous phase (PVP) and/or transitional phase (TP); and capsular enhancement. Quantitative analysis was also conducted.Statistical TestsUnivariate and multivariate analyses were performed to determine the significant MRI findings, and their diagnostic performance for the prediction of HHN was analyzed.ResultsLesion size of ≤16 mm (odds ratio [OR], 24.41; P = 0.007), low-to-iso SI on DWI (OR, 26.92; P = 0.007), and absence of washout on PVP and/or TP (OR, 31.84; P = 0.009) were significant independent factors for predicting HHN. When all three criteria were satisfied, the specificity was 100%. Compared with hHCCs, HHNs showed significantly smaller size (mean, 13.8 mm vs. 19.9 mm; P < 0.001) and higher mean SI value (994.0 vs. 669.5) and lesion-to-liver SI ratio (1.045 vs. 0.806) on HBP (P < 0.001, respectively).Data ConclusionGd-EOB-MRI and DWI may be helpful in differentiating HHN from small hHCC in patients with ALC.Level Of Evidence3 Technical Efficacy Stage: 2 J. Magn. Reson. Imaging 2020;51:70-80.© 2019 International Society for Magnetic Resonance in Medicine.

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