Between November 2003 and January 2010, we prospectively included 159 cirrhotic patients with a newly detected solitary nodule between 5 and 20 mm in diameter by screening ultrasonography (US). Hepatic MRI and fine-needle biopsy were performed in all patients.
Final diagnoses were hepatocellular carcinoma (HCC) (n = 103), other malignant lesions (intrahepatic cholangiocarcinoma/metastases) (n = 4), and benign lesions (n = 52). The specific enhancement pattern (arterial enhancement followed by washout) yielded a sensitivity and specificity of 58.3%and 96.4%, respectively. Peritumoral capsule was present in 43 HCC and in 2 non-HCC lesions. Intralesional fat was detected in 24 nodules; 5 nodules were non-HCC. Finally, the presence of both capsule and fat was observed in 10 cases, all of them HCC (100%specificity), but all of them also displayed the specific enhancement pattern, thus adding no sensitivity or specificity.
Conclusive non-invasive diagnosis of HCC in cirrhosis should be based only on the contrast enhancement pattern, while other characteristics at MRI do not increase the diagnostic accuracy.