Abstract: Objective The aim of this study was to investigate the diagnostic efficacy of GD-EOB-DTPA enhanced magnetic resonance imaging (MRI) in differentiation of primary liver cancer (PLC) fromnodular regenerative hyperplasia of liver (NRH) in patients with hepatitis B cirrhosis. Methods 147 patients with hepatic focal lesions (HFL) in the background of hepatitis B cirrhosis were encountered in our hospital between December 2018 and December 2020, and all patients underwent GD-Eob-DTPA enhanced MRI scan. The foci enhancement characteristics and signal intensity in each sequence were observed, including T1-weighted image (T1WI), T2-weighted image (T2WI), and signal intensity of arterial phase, portal vein phase, hepatobiliary specific phase, and magnetic resonance diffusion weighted imaging (DWI). The area under receiver operating characteristic (ROC) curve (AUC) was applied to analyze the diagnostic efficacy of signal feature. Results Out of our 147 patients with HFL, the contrast-enhanced MRI scan made diagnosis of PLC in 102 cases, with the lesion size of 0.9-2.9 cm (average of 1.8±0.6 cm), and NRH in 45 cases, with lesion size of 0.8-2.5 cm (average of 1.4±0.2 cm); the enhanced MRI scan showed that low or equal enhancement in arterial phase, low enhancement in portal vein phase or in delayed phase in 84 cases, and significant enhancement in arterial stage, without clearance in portal or delayed stage in 63 cases; the proportions of low signal in T₁WI, high signal in T₂WI, high signal in DWI, increased enhancement in arterial phase, and low signal in hepatobiliary phase in patients with PLC were 50.0%, 79.4%, 82.4%, 52.9%, and 94.1%, significantly higher than 20.0%, 20.0%, 26.7%, 20.0% and 20.0% (P<0.05) in patients with NRH; the ROC analysis showed that the low signal in T₁WI (AUC=0.670, sensitivity=0.451), high signal in T₂WI (AUC=0.817, sensitivity=0.745), high signal in DWI (AUC=0.754, sensitivity=0.863), high enhancement in arterial phase (AUC=0.693, sensitivity=0.520) and low signal in hepatobiliary phase (AUC=0.891, sensitivity=0.892) had certain diagnostic efficacy for PLC (P<0.05). Conclusion The enhanced MRI scan plays an important role in the diagnosis of PLC under the background of hepatitis B-induced liver cirrhosis.

Key words: Hepatoma, Nodular regenerative hyperplasia, Liver cirrhosis, Magnetic resonance imaging, Gadolinium ethoxybenzyl diethylenetriaminepentaacetic acid, Diagnosis