Enhancing capsule in hepatocellular carcinoma: intra-individual comparison between CT and MRI with extracellular contrast agent - 18/07/21

Doi : 10.1016/j.diii.2021.06.004

Roberto Cannella ^a,^b,^c, Maxime Ronot ^a,^d, Riccardo Sartoris ^a,^d, Francois Cauchy ^e, Christian Hobeika ^e, Aurélie Beaufrere ^f, Loïc Trapani ^f, Valérie Paradis ^f, Mohamed Bouattour ^g, Fanny Bonvalet ^a, Valérie Vilgrain ^a,^d, Marco Dioguardi Burgio ^a,^d,^⁎
^a Department of Radiology, AP-HP.Nord, Hôpital Beaujon, 92110 Clichy, France
^b Section of Radiology - BiND, University Hospital “Paolo Giaccone”, 90127 Palermo, Italy
^c Department of Health Promotion Sciences Maternal and Infant Care, Internal Medicine and Medical Specialties, PROMISE, University of Palermo, 90127 Palermo, Italy
^d Université de Paris, Faculté de Médecine & INSERM U1149 "centre de recherche sur l'inflammation”, CRI, F-75018 Paris, France
^e Department of HPB Surgery and Liver Transplantation, AP-HP.Nord, Hôpital Beaujon, 92110 Clichy, France
^f Department of Pathology, AP-HP.Nord, Hôpital Beaujon, 92110 Clichy, France
^g Department of Digestive Oncology, AP-HP.Nord, Hôpital Beaujon, 92110 Clichy, France

^⁎Corresponding author at: Department of Radiology, AP-HP.Nord, Hôpital Beaujon, 100 Boulevard du Général Leclerc, 92110 Clichy, France.Department of RadiologyAP-HP.NordHôpital Beaujon100 Boulevard du Général LeclercClichy92110France

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Highlights

•	Capsule enhancement is more commonly depicted on extracellular contrast agent-MRI than on contrast-enhanced CT.
•	MRI using extracellular contrast agent conveys greater sensitivity for the diagnosis of tumor capsule compared to contrast-enhanced CT.
•	The specificity of contrast-enhanced CT is significantly greater than that of MRI with extracellular contrast agent for the diagnosis of histopathologically confirmed tumor capsule.
•	Inter-reader agreement for the presence of capsule enhancement is moderate for both contrast-enhanced CT and MRI with extracellular contrast agent.

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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.

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Keywords : Capsule, Computed tomography, Extracellular contrast agent, Hepatocellular carcinoma, Magnetic resonance imaging

Abbreviations : CI, CT, ECA-MRI, HCC, LI-RADS, MRI, SD