Purpose

The aim of this study was to determine whether gadoxetate-enhanced magnetic resonance imaging (MRI) improves lesion characterization in patients at risk for hepatocellular carcinoma compared with computed tomography (CT).

Materials and methods

Forty-nine patients with indeterminate lesions found at contrast-enhanced CT were prospectively enrolled and imaged using gadoxetate-enhanced hepatobiliary phase (HBP) MRI within 30 days of their initial CT. Three readers graded each lesion at CT and MRI using the Liver Imaging Reporting and Data System (LI-RADS) v2014 major criteria and HBP characterization as an ancillary feature. Patients were followed for an average of 1.8 years to document growth or stability of each lesion.

Results

The Liver Imaging Reporting and Data System categorization changed for 71% (52/73) of lesions based on HBP MRI compared with CT, with 30% (22/73) of lesions upgraded and 41% (30/73) of lesions downgraded. There was almost perfect agreement between readers for arterial phase hyperintensity and HBP hypointensity, with lower interreader agreement for washout and capsule appearance. On the basis of composite clinical follow-up, lesions that were subsequently classified as hepatocellular carcinoma were assigned a higher LI-RADS category on HBP MRI when compared with CT.

Conclusions

For patients with indeterminate lesions seen on contrast-enhanced CT, HBP MRI using gadoxetate improves lesion characterization when using LI-RADS v2014 criteria.

Purpose

Endoscopy is recommended to screen for esophageal varices in patients with cirrhosis. The objective of this study was to identify features on abdominal CT imaging associated variceal hemorrhage (VH).

Methods

A case-control study was performed among patients with cirrhosis who had a CT scan. Consecutive patients who experienced VH were included as cases, and patients without VH served as controls. Two radiologists recorded the maximal esophageal varix diameter in addition to other measures of portal hypertension at CT.

Results

The most powerful CT parameter associated with VH was the esophageal varix diameter (5.8 vs. 2.7 mm, p < 0.001; adjusted OR 1.84 per mm, p = 0.009). 63% of individuals with VH had a maximal varix diameter ≥5 mm compared to 7.5% of cirrhotic patients without VH (p < 0.001). In contrast, the proportion of individuals whose largest varix was <3 mm was 7.4% among VH cases compared to 54.7% among controls (p = 0.001). The varix diameter powerfully discriminated those with and without VH (C-statistic 0.84).

Conclusions

A large esophageal varix diameter is strongly associated with subsequent VH. A threshold of <3 and ≥5 mm appears to identify patients with cirrhosis at low and high risk for hemorrhage.