Editorial for “visualization Score of Gadoxetic Acid‐Enhanced Magnetic Resonance Imaging: the Effect on the Diagnostic Accuracy for Hepatocellular Carcinoma”

Background The visualization score of hepatobiliary‐phase (HBP) images has been introduced as an image quality index for gadoxetic acid‐enhanced MRI. It may be associated with hepatic function and could have an implication on the diagnostic accuracy for hepatocellular carcinoma (HCC). Purpose To investigate the association between the visualization score of gadoxetic acid‐enhanced MRI and clinical factors and to evaluate its effect on the diagnostic accuracy for HCC ≤ 3.0 cm. Study type Retrospective. Population A total of 493 focal lesions from 397 patients. Field strength/Sequence A 5‐T or 3.0 ‐T with pre/postcontrast T1 ‐weighted 3D gradient echo sequence, and T2 ‐weighted fast spin‐echo sequence Assessment Child‐Pugh classification and albumin‐bilirubin (ALBI) score were assessed. Three readers evaluated the visualization score of each MRI examination (A, no or minimal; B, moderate; and C, severe limitations), and major features (arterial‐phase hyperenhancement, washout, enhancing capsule, threshold growth) and ancillary features of each focal lesion. Statistical Tests Univariable and multivariable logistic regression analyses were performed to determine significant clinical factors associated with a suboptimal visualization score (B or C). Generalized estimating equations were used to compare the sensitivity and specificity for diagnosing HCC between the two group (visualization score A vs. B or C). A P value < 0.05 was considered statistically significant. Results Of the 397 MRI examinations, the incidence of suboptimal visualization score was 13%. A suboptimal visualization score was significantly associated with Child‐Pugh classification B or C (adjusted odds ratio [OR] = 15.2) and ALBI grade 2 or 3 (OR = 4.7). Compared with the visualization score A group, the suboptimal visualization score group showed significantly lower sensitivity (56.8% vs. 75.2%) and less frequent washout in HCC (62.2% vs. 84.0%). Data Conclusion The visualization score on gadoxetic acid‐enhanced MRI can be an important image quality index and the diagnostic accuracy for HCC ≤ 3.0 cm may not be sufficient in the suboptimal visualization score group. Level of Evidence 3 Technical Efficacy Stage 3