A gadoxetic-acid enhancement flux analysis of small liver nodules (≤2 cm) in patients at high risk of hepatocellular carcinoma

Purpose To discriminate between benignities and hepatocellular carcinomas (HCCs) in patients at high risk of HCC using a novel enhancement flux analysis for gadoxetic-acid enhanced MRI. Method This study retrospectively collected 181 liver nodules in 156 patients at high risk of HCC who underwent gadoxetic acid-enhanced MRI examinations with following surgical resection from 1st August 2017 to 31st December 2021 as the training set; another 42 liver nodules in 36 patients were prospectively collected from 1st January 2022 to 1st October 2022 as the test set. The time-intensity curves (TICs) of liver nodules were formed with consecutive time points: 0 s, 20 s, 1 min, 2 min, 5 min, 10 min, 15 min, and 20 min since contrast injection. A novel enhancement flux analysis was applied by using a biexponential function fitting to distinguish benignities and HCC. Besides, previously published models including maximum enhancement ratio ( ER max ), percentage signal ratio ( PSR ), and ER max + P S R were compared. The areas under the receiver operating characteristic curves (AUCs) were compared among these methods. Results The novel enhancement flux analysis showed the highest AUCs in the training set (0.897, 95%CI: 0.833–0.960) and the test set (0.859, 95%CI: 0.747–0.970) among all models. The AUCs of PSR , ER max and ER max + P S R were 0.801 (95%CI: 0.710–0.891), 0.620 (95%CI: 0.510–0.729), and 0.799 (95%CI: 0.709–0.889) in the training set, and were 0.701 (95%CI: 0.539–0.863), 0.529 (95%CI: 0.342–0.717), and 0.708 (95%CI: 0.549–0.867) in the test set. Conclusions The biexponential flux analysis for gadoxetic-acid enhanced MRI presents a better potential in accurate diagnosis of small HCC nodules.