Background: Correct characterization of focal solid hepatic lesions has always been a challenge and is of great\r\ndiagnostic and therapeutic relevance. The purpose of this study was to determine the added value of hepatobiliary\r\nphase images in Gd-EOB-DTPA-enhanced magnetic resonance imaging (MRI) for differentiating focal solid\r\nhepatic lesions.\r\nMethods: In this retrospective trial 84 consecutive patients underwent Gd-EOB-DTPA-enhanced MR examinations.\r\nMRI was conducted for 64 patients with malignant focal hepatic lesions (34 hepatocellular carcinoma (HCC),\r\n30 metastases) and for 20 patients with benign hepatic lesions (14 focal nodular hyperplasia (FNH), 3 adenoma,\r\n3 hemangioma). Five radiologists independently reviewed three sets of MR images by means of a 5-point\r\nconfidence scale from score 1 (definitely benign) to score 5 (definitely malignant): set 1: unenhanced images; set 2:\r\nunenhanced and Gd-EOB-DTPA-enhanced dynamic images; set 3: hepatobiliary phase images in addition to set 2.\r\nAccuracy was assessed by the alternative free-response receiver operating characteristic curve (Az) and the index\r\nof diagnostic performance was calculated.\r\nResults: Diagnostic accuracy was significantly improved by the addition of Gd-EOB-DTPA-enhanced dynamic\r\nimages: Az in set 1 was 0.708 and 0.833 in set 2 (P = 0.0002). The addition of hepatobiliary phase images\r\nincreased the Az value to 0.941 in set 3 (set 3 vs set 2, P < 0.0001; set 3 vs set 1, P < 0.0001). The index of diagnostic\r\nperformance was lowest in set 1 (45%), improved in set 2 (71%), and highest in set 3 (94%).\r\nConclusions: Hepatobiliary phase images obtained after Gd-EOB-DTPA-enhanced dynamic MRI improve the\r\ndifferentiation of focal solid hepatic lesions.
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