Ring-Like Enhancement of Hepatocellular Carcinoma in Gadoxetic Acid-Enhanced Multiphasic Hepatic Arterial Phase Imaging With Differential Subsampling With Cartesian Ordering

Invest Radiol. 2018 Apr;53(4):191-199. doi: 10.1097/RLI.0000000000000428.


Objective: The aim of this study was to evaluate the efficacy of multiphasic hepatic arterial phase (HAP) imaging using DISCO (differential subsampling with Cartesian ordering) in increasing the confidence of diagnosis of hepatocellular carcinoma (HCC).

Materials and methods: This retrospective study was approved by the institutional review board, and the requirement for informed patient consent was waived. Consecutive patients (from 2 study periods) with malignant liver nodules were examined by gadoxetic acid-enhanced magnetic resonance imaging using either multiphasic (6 phases; n = 135) or single (n = 230) HAP imaging, which revealed 519 liver nodules other than benign ones (HCC, 497; cholangiocarcinoma, 11; metastases, 10; and malignant lymphoma, 1). All nodules were scored in accordance with the Liver Imaging Reporting and Data System (LI-RADS v2014), with or without consideration of ring-like enhancement in multiphasic HAP images as a major feature.

Results: In the multiphasic HAP group, 178 of 191 HCCs were scored as LR-3 to LR-5 (3 [1.69%], 85 [47.8%], and 90 [50.6%], respectively). Upon considering ring-like enhancement in multiphasic HAP images as a major feature, 5 more HCCs were scored as LR-5 (95 [53.4%]), which was a significantly more confident diagnosis than that with single HAP images (295 of 306 HCCs scored as LR-3 to LR-5: 13 [4.41%], 147 [49.8%], and 135 [45.8%], respectively; P = 0.0296). There was no significant difference in false-positive or false-negative diagnoses between the multiphasic and single HAP groups (P = 0.8400 and 0.1043, respectively).

Conclusions: Multiphasic HAP imaging can improve the confidence of diagnosis of HCCs in gadoxetic acid-enhanced magnetic resonance imaging.

MeSH terms

  • Aged
  • Aged, 80 and over
  • Carcinoma, Hepatocellular / diagnostic imaging*
  • Carcinoma, Hepatocellular / pathology
  • Contrast Media
  • Female
  • Gadolinium DTPA*
  • Hepatic Artery / diagnostic imaging
  • Hepatic Artery / pathology
  • Humans
  • Image Enhancement / methods*
  • Image Processing, Computer-Assisted / methods*
  • Liver Neoplasms / diagnostic imaging*
  • Liver Neoplasms / pathology
  • Magnetic Resonance Imaging / methods*
  • Male
  • Middle Aged
  • Reproducibility of Results
  • Retrospective Studies


  • Contrast Media
  • gadolinium ethoxybenzyl DTPA
  • Gadolinium DTPA