Improved Diagnosis of Capsule in Hepatocallular Carcinoma by Adding Nonenhancing Capsule to Enhancing Capsule in Gadoxetic Acid-Enhanced MRI

Abstract To assess the value of nonenhancing capsule by adding to enhancing capsule in gadoxetic acid-enhanced MRI (EOB-MRI) in comparison with contrast-enhanced CT (CE-CT) for diagnosing hepatocellular carcinoma (HCC). One-hundred fifty-one patients with HCC who underwent both CE-CT and EOB-MRI were retrospectively reviewed. Liver Imaging-Reporting and Data System (LI-RADS) v2018 imaging features, including enhancing and nonenhancing capsule were evaluated by two readers in CE-CT and EOB-MRI. Frequencies of each imaging feature were compared between CE-CT and EOB-MRI. The area under the receiver operating characteristic (AUC) curve for the diagnosis of histological capsule was compared across the following three imaging criteria: (1) enhancing capsule in CE-CT, (2) enhancing capsule in EOB-MRI, and (3) enhancing/nonenhancing capsule in EOB-MRI. Enhancing capsule in EOB-MRI was significantly less frequently depicted than that in CE-CT (p = < 0.001–0.016). Enhancing/nonenhancing capsule in EOB-MRI achieved a similar frequency of enhancing in CE-CT (p = 0.465–0.590). Adding nonenhancing capsule to enhancing capsule in EOB-MRI significantly increased AUCs (p < 0.001) and achieved similar AUCs compared with enhancing capsule in CE-CT (p = 0.470–0.666) in both readers. Adding nonenhancing capsule to the definition of capsule appearance can improve the diagnosis of capsule in EOB-MRI and decrease discordance of capsule appearance between EOB-MRI and CE-CT.