Roberto Cannella1, Maxime Ronot2, Riccardo Sartoris2, Francois Cauchy3, Christian Hobeika3, Aurélie Beaufrere4, Loïc Trapani4, Valérie Paradis4, Mohamed Bouattour5, Fanny Bonvalet6, Valérie Vilgrain2, Marco Dioguardi Burgio7. 1. Department of Radiology, AP-HP.Nord, Hôpital Beaujon, 92110 Clichy, France; Section of Radiology - BiND, University Hospital "Paolo Giaccone", 90127 Palermo, Italy; Department of Health Promotion Sciences Maternal and Infant Care, Internal Medicine and Medical Specialties, PROMISE, University of Palermo, 90127 Palermo, Italy. 2. Department of Radiology, AP-HP.Nord, Hôpital Beaujon, 92110 Clichy, France; Université de Paris, Faculté de Médecine & INSERM U1149 "centre de recherche sur l'inflammation", CRI, F-75018 Paris, France. 3. Department of HPB Surgery and Liver Transplantation, AP-HP.Nord, Hôpital Beaujon, 92110 Clichy, France. 4. Department of Pathology, AP-HP.Nord, Hôpital Beaujon, 92110 Clichy, France. 5. Department of Digestive Oncology, AP-HP.Nord, Hôpital Beaujon, 92110 Clichy, France. 6. Department of Radiology, AP-HP.Nord, Hôpital Beaujon, 92110 Clichy, France. 7. Department of Radiology, AP-HP.Nord, Hôpital Beaujon, 92110 Clichy, France; Université de Paris, Faculté de Médecine & INSERM U1149 "centre de recherche sur l'inflammation", CRI, F-75018 Paris, France. Electronic address: marco.dioguardiburgio@aphp.fr.
Abstract
PURPOSE: The purpose of this study was to compare the value of contrast-enhanced computed tomography (CT) to that of magnetic resonance imaging obtained with extracellular contrast agent (ECA-MRI) for the diagnosis of a tumor capsule in hepatocellular carcinoma (HCC) using histopathologic findings as the standard of reference. MATERIALS AND METHODS: This retrospective study included patients with pathologically-proven resected HCCs with available preoperative contrast-enhanced CT and ECA-MRI examinations. Two blinded radiologists independently reviewed contrast-enhanced CT and ECA-MRI examinations to assess the presence of an enhancing capsule. The histopathological analysis of resected specimens was used as reference for the diagnosis of a tumor capsule. The sensitivity and specificity of CT and ECA-MRI for the diagnosis of a tumor capsule were determined, and an intra-individual comparison of imaging modalities was performed using McNemar test. Inter-reader agreement was assessed using Kappa test. RESULTS: The study population included 199 patients (157 men, 42 women; mean age: 61.3 ± 13.0 [SD] years) with 210 HCCs (mean size 56.7 ± 43.7 [SD] mm). A tumor capsule was present in 157/210 (74.8%) HCCs at histopathologic analysis. Capsule enhancement was more frequently visualized on ECA-MRI (R1, 68.6%; R2, 71.9%) than on CT (R1, 44.3%, P < 0.001; R2, 47.6%, P < 0.001). The sensitivity of ECA-MRI was better for the diagnosis of histopathological tumor capsule (R1, 76.4%; R2, 79.6%; P < 0.001), while CT had a greater specificity (R1, 84.9%; R2, 83.0%; P < 0.001). Inter-reader agreement was moderate both on CT (kappa = 0.55; 95% confidence interval [CI]: 0.43-0.66) and ECA-MRI (kappa = 0.57; 95% CI: 0.45-0.70). CONCLUSION: Capsule enhancement was more frequently visualized on ECA-MRI than on CT. The sensitivity of ECA-MRI was greater than that of CT, but the specificity of CT was better than that of ECA-MRI.
PURPOSE: The purpose of this study was to compare the value of contrast-enhanced computed tomography (CT) to that of magnetic resonance imaging obtained with extracellular contrast agent (ECA-MRI) for the diagnosis of a tumor capsule in hepatocellular carcinoma (HCC) using histopathologic findings as the standard of reference. MATERIALS AND METHODS: This retrospective study included patients with pathologically-proven resected HCCs with available preoperative contrast-enhanced CT and ECA-MRI examinations. Two blinded radiologists independently reviewed contrast-enhanced CT and ECA-MRI examinations to assess the presence of an enhancing capsule. The histopathological analysis of resected specimens was used as reference for the diagnosis of a tumor capsule. The sensitivity and specificity of CT and ECA-MRI for the diagnosis of a tumor capsule were determined, and an intra-individual comparison of imaging modalities was performed using McNemar test. Inter-reader agreement was assessed using Kappa test. RESULTS: The study population included 199 patients (157 men, 42 women; mean age: 61.3 ± 13.0 [SD] years) with 210 HCCs (mean size 56.7 ± 43.7 [SD] mm). A tumor capsule was present in 157/210 (74.8%) HCCs at histopathologic analysis. Capsule enhancement was more frequently visualized on ECA-MRI (R1, 68.6%; R2, 71.9%) than on CT (R1, 44.3%, P < 0.001; R2, 47.6%, P < 0.001). The sensitivity of ECA-MRI was better for the diagnosis of histopathological tumor capsule (R1, 76.4%; R2, 79.6%; P < 0.001), while CT had a greater specificity (R1, 84.9%; R2, 83.0%; P < 0.001). Inter-reader agreement was moderate both on CT (kappa = 0.55; 95% confidence interval [CI]: 0.43-0.66) and ECA-MRI (kappa = 0.57; 95% CI: 0.45-0.70). CONCLUSION: Capsule enhancement was more frequently visualized on ECA-MRI than on CT. The sensitivity of ECA-MRI was greater than that of CT, but the specificity of CT was better than that of ECA-MRI.