Distinguishing Hemangiomas From Malignant Solid Hepatic Lesions: A Comparison of Heavily T2-Weighted Images Obtained Before and After Administration of Gadoxetic Acid

Purpose: To compare the use of heavily T2-weighted images obtained before and after administration of gadoxetic acid in differentiating hemangiomas from malignant solid hepatic lesions. Materials and Methods: Heavily T2-weighted images (TE = 150 msec) were obtained for 70 patients (42 men and 28 women) with 74 focal hepatic lesions (25 hepatocellular carcinomas [HCC], 22 metastases, and 27 hemangiomas) <= 3 cm in diameter before and after gadoxetic acid-enhanced dynamic magnetic resonance imaging (MRI). Quantitative analysis was performed using receiver operating characteristic (ROC) curves with lesion-to-liver signal intensity difference-to-noise ratio (SDNR) on precontrast and postcontrast images. Qualitative analysis was also performed by two blinded reviewers. Results: The SDNR of the solid lesions was significantly higher on the postcontrast (1.66 +/- 1.18) than on the precontrast (1.38 +/- 1.07) images (P = 0.0012), while the SDNR of hemangiomas was comparable for pre- and postcontrast images (P = 0.8164). The best SDNR cutoff values for distinguishing solid lesions from hemangiomas were <= 1.85 (Az = 0.948) for precontrast and <= 2.58 (Az = 0.901) for postcontrast images (P = 0.057). Reader performances for distinguishing hemangiomas from solid lesions were comparable between the precontrast (Az = 0.975 and 0.970 for readers 1 and 2) and postcontrast (Az = 0.977 and 0.972) images (P = 0.899 and 0.946). Conclusion: Heavily T2-weighted images obtained after administration of gadoxetic acid have a diagnostic capability comparable to precontrast images for differentiating between small hemangiomas and malignant solid lesions of the liver.