Abstract
Background: The purpose of the study was to compare and contrast the diagnostics of multiphasic computed tomography (CT) and magnetic resonance imaging (MRI) in the diagnosis, characterization, and staging of focal lesions of the liver in patients with chronic liver disease. It is imperative to have the right imaging to diagnose the disease early, plan the treatment, and prognoses in the high-risk patients.
Objective: The purpose of the study was to compare the diagnostic accuracy of multiphasic contrast-enhanced CT and contrast-enhanced MRI in the detection and characterization of focal liver lesions (FLLs) in patients with chronic liver disease.
Method: 95 focal liver lesions in 60 patients were detected in chronic liver disease to conduct this prospective study. Multiphase CT and MRI were done on all patients and lesions assessed in terms of detection, characterization, size, location and vascular invasion. The reference standard was histopathology or subsequent imaging. The parameters of diagnostics, such as sensitivity, specificity, positive and negative predictive value, and overall accuracy were then estimated and compared between CT and MRI. The inter-observer agreement was also evaluated.
Result: MRI showed better performance in all the parameters that were considered as compared to CT. The overall sensitivity, specificity and accuracy of MRI was 93.7, 86.1 and 91.6 respectively and the same was 84.2, 80.9 and 83.2 with CT. It was observed that MRI was able to detect small lesions (less than 1 cm), atypical nodules, and lesions that were in anatomically difficult areas like the caudate lobe. Characterization of lesions was also precise in 91.6 percent of cases using MRI as opposed to 83.2 using CT. MRI was also superior to CT in terms of vascular invasion (17.9% cases detected), and inter-observer reproducibility.
Conclusion: MRI is more accurate in the diagnosis of focal lesions of the liver in chronic liver disease, especially lesions that are small, atypical or complicated lesions, and in the measurement of vascular invasion. CT cannot be ignored as an assessment tool because it is rapid and initial, but MRI should be given preference when it comes to definitive assessment and treatment planning. Inclusion of MRI into clinical pathway will aid in early diagnosis, accurate characterization and optimal management of the chronically liver disease patients.