Multiple arterial‐phase MRI with gadoxetic acid improves diagnosis of hepatocellular carcinoma ≤3.0 cm

Background and Aims Multiple arterial‐phase magnetic resonance imaging (MA‐MRI) was introduced to overcome the limitations of gadoxetic acid‐enhanced MRI, but its clinical impacts on hepatocellular carcinoma (HCC) diagnosis have not been well assessed. We investigated whether MA‐MRI with gadoxetic acid could improve the diagnosis of HCC ≤3.0 cm in comparison with single arterial‐phase MRI (SA‐MRI). Methods This retrospective study included 397 patients from two tertiary institutions who underwent gadoxetic acid‐enhanced MRI (243 patients with 271 lesions in cohort‐1 underwent SA‐MRI, and 154 patients with 166 lesions in cohort‐2 underwent MA‐MRI). The patients had 437 hepatic lesions ≤3.0 cm with pathologic confirmation. The arterial‐phase image quality and diagnostic performance of SA‐MRI and MA‐MRI were analysed and compared. To minimize the effects of selection bias because of potential confounding between the two groups, propensity score‐matching was additionally performed. Results MA‐MRI showed a significantly higher percentage of optimal arterial‐phase timing (94.2% vs. 74.5%, p