Comparison of HCC Tumor-Size measured in MRI and Histopathology – Does the Sequence matter?
Marco Armbruster1, Dominik Nörenberg1, Katharina Hoffmann2, Joachim Andrassy2, and Harald Kramer1

1Department of Clinical Radiology, Ludwig-Maximilian-University Munich, Munich, Germany, 2Department of Visceral Surgery, Ludwig-Maximilian-University Munich, Munich, Germany


Size measurements of hepatocellular carcinoma lesions play an important role in treatment algorithms of this disease, however little is known about which MRI sequence has the highest accuracy. This study shows, that there is a significant variance in size assessment of different MRI sequences and phases, while the hepatobiliary-phase seems to be best correlated to histopathologic measurements as the standard of reference and delineates HCC lesions most sharply.


The exact size of hepatocellular carcinoma (HCC) lesions plays an important role in treatment algorithms of this disease1-5. Therefore, the objective of our study was to compare size measurements of HCC lesions between different MRI sequences and to evaluate their accuracy using histopathology as the standard of reference.

Material & Methods:

We included 53 patients with known HCC who underwent contrast-enhanced MRI of the liver prior to liver transplantation or tumor resection within 90 days. Pathologically assessed tumor-size was available for all patients. The MRI protocol contained axial T2-weighted sequences as well as T1-weighted sequences before and after application of Gd-EOB-DTPA. Tumor diameters were measured on all available MRI sequences. Furthermore the sharpness of lesions and the presence of artifacts were evaluated visually. MRI measurements and pathologically assessed dimensions were correlated using pearson’s correlation coefficient.


Mean time between MRI and resection was 21±19 days. Artifacts were present in 9% of T2w turbo-spin-echo (tse) images, 6% of portal-venous-, and 4% of arterial-phase datasets, while there were no artifacts present in hepatobiliary-phase images. HCCs frequently showed up with fuzzy edges in arterial- and late-venous-phase datasets (49%, 45% respectively), while they presented sharply delineated in 85% of all hepatobiliary-phase images. On average there was a deviation from the pathologically measured tumor diameter of 0.93cm±0.89cm (R=0.93) for T2w tse images, 0.86cm±0.97cm (R=0.93) for the arterial-, 0.83cm±0.93cm (R=0.94) for the late-venous-, and 0.79cm±0.82cm (R=0.95) for the hepatobiliary-phase.


The hepatobiliary-phase delineates HCC lesions sharply and seems to be most accurate along commonly used MRI sequences to measure HCC tumor-size.


We thank Prof. Dr. Maximilian Reiser for his valuable input to this study.


1. Mazzaferro V, Regalia E, Doci R et al; Liver transplantation for the treatment of small hepatocellular carcinomas in patients with cirrhosis. The New England Journal of Medicine. 1996 Mar 14,334(11):693-9

2. Mazzaferro V, Bhoori S, Sposito C et al; Milan criteria in liver transplantation for hepatocellular carcinoma: an evidence-based analysis of 15 years of experience. Liver Transplantation. 2011 Oct 17 Suppl 2:44-57

3. Forner A, Llovet JM, Bruix J; Hepatocellular carcinoma. Lancet 2012; 379:1245

4. Bruix, J, Sherman, M. ; AASLD Practice Guideline, Management of Hepatocellular Carcinoma: An Update. (Accessed on November 01, 2015).

5. European Association for Study of Liver, European Organisation for Research and Treatment of Cancer. EASL-EORTC clinical practice guidelines: management of hepatocellular carcinoma. Eur J Cancer 2012; 48:599.


56yr old female patient with histopathological proven hepatocellular carcinoma. Size measurements of HCC in preoperative MRI revelas a significant variability of 5mm between the measured diameters depending on sequence and phase..

a) T2w turbo-spin-echo fat-sat b) T1w arterial phase after application of Gd-EOB-DTPA c) T1w portal venous phase d) Hepatobiliary phase 20min after contrast injection.

Proc. Intl. Soc. Mag. Reson. Med. 24 (2016)