Imaging Requirements for Utilization of T2*-Weighted Magnetic Resonance Imaging for Identification of Hepatocellular Carcinoma in Cirrhosis: Effect of Hepatic Iron Content.

Purpose: To evaluate the impact of the level of inherent hepatic iron deposition on the ability of multiecho T2*-weighted magnetic resonance imaging (T2*WI) to identify hepatocellular carcinoma. This is relevant to the ancillary features described in the Liver Imaging Reporting and Data System reporting system.

Methods: This retrospective review identified liver transplant patients with a preoperative magnetic resonance imaging at 1.5 T including gradient-recalled echo T2*WI (echo time, 9.5, 19.3, 29.0 milliseconds). A blinded, randomized reading was performed by a single reader of each of the images at each echo time. Hepatic iron content (HIC) was calculated for each participant and compared with the results of the blinded read.

Results: Ninety-eight HCCs were identified on explant pathology in 73 participants. Of these, 57 HCCs (58%) were identified on T2*WI. However, no HCCs were visible in participants with HIC < 1.0 mg/g. For participants with HIC > 1.0 mg/g, 57 (88%) of 65 HCCs were visible.

Conclusions: Most of HCCs can be identified on T2*WI without gadolinium; however, performance is significantly affected by background HIC.