Comparison of Gd-EOB-DTPA-enhanced MRI versus multiphasic enhanced CT for detecting occult recurrence after curative ablation of hepatocellular carcinoma

Objective: To evaluate the value of Gd-EOB-DTPA-enhanced MRI in the early diagnosis of occult intrahepatic recurrence after curative ablation for hepatocellular carcinoma (HCC). Materials and methods: This retrospective study included 74 HCC patients who underwent curative microwave ablation, divided into a CT group and a CT+MRI group. An expert committee determined recurrence via consensus readout. Diagnostic accuracy, sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and the area under the receiver operating characteristic curve (AUROC) of the two imaging methods were compared through blinded image review. Results: With a median follow-up of 23.5 months, 38 patients (51.4%) were diagnosed with recurrence. Within the CT+MRI group, the sensitivity of Gd-EOB-DTPA-enhanced MRI for diagnosing recurrent patients was significantly higher than that of enhanced CT (P < 0.05), leading to altered BCLC stages in 2 patients. Low signal intensity on the hepatobiliary phase was the most sensitive finding. Diagnostic performance analysis confirmed that the AUROC and sensitivity of Gd-EOB-DTPA-enhanced MRI were significantly superior to those of enhanced CT (all P < 0.05). Conclusion: Gd-EOB-DTPA-enhanced MRI demonstrated superior diagnostic performance compared with multiphasic contrast-enhanced CT for detecting CT-occult intrahepatic recurrence after curative MWA. However, because MRI was selectively performed in patients with high-risk features, elevated AFP, or equivocal CT findings, its benefit is best interpreted as an adjunctive tool in this targeted population rather than a routine replacement for CT surveillance. A risk-stratified follow-up strategy may optimize clinical benefit and cost-effectiveness.