Combining the Arterial Phase of Contrast-Enhanced Ultrasonography, Gadoxetic Acid-Enhanced Magnetic Resonance Imaging and Diffusion-Weighted Imaging in the Diagnosis of Hepatic Nodules ≤20 mm in Patients with Cirrhosis.

Contrast-enhanced ultrasonography (CEUS) and gadoxetic acid-enhanced magnetic resonance imaging (EOB-MRI) were compared with respect to diagnostic efficacy in the detection of small hepatocellular carcinoma. A new diagnostic strategy that combines the arterial phase of CEUS, the hepatobiliary phase of EOB-MRI and diffusion-weighted MR imaging (DWI) is described. One hundred sixteen nodules were enrolled to validate the performance of the strategy. For lesions ≤20 mm in size, the areas under the receiver operating characteristic curves (Az) of CEUS and EOB-MRI were 0.930 (95% confidence interval [CI]: 0.867-0.969) and 0.920 (95% CI: 0.855-0.962) (p = 0.796), respectively. The Az value of the new diagnostic strategy was 0.985 (95% CI: 0.942-0.999) (vs. CEUS, p = 0.026; vs. EOB-MRI, p = 0.014). The sensitivity, specificity and diagnostic accuracy of the new strategy were 95.5% (95% CI: 88.9%-98.8%), 96.3% (95% CI: 81.0%-99.9%) and 95.7% (95% CI: 91.9%-99.4%), respectively. The new diagnostic strategy based on the arterial phase of CEUS, hepatobiliary phase of EOB-MRI and DWI represents an appealing solution for distinguishing small hepatocellular carcinomas from benign lesions, especially when the nodules present atypical enhancement patterns.