Can the Patient With Cirrhosis Be Imaged for Hepatocellular Carcinoma Without Gadolinium?

Hardie, Andrew D.; Kizziah, Michael K.; Rissing, Michael S.

doi:10.1097/rct.0b013e31823421ac

Cited by 15 publications

(4 citation statements)

References 12 publications

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“…SWI showed a sensitivity, accuracy, and PPV of 84.4% and 84.4%, 85.4% and 83.8%, 98.5% and 98.2% for lesion-based and patient-based analysis, respectively. This was consistent with the study by Hardie et al They found that T2*WI had a sensitivity and specificity of 60% and 100% for identifying HCC and a greater degree of liver iron deposition allowed for increased conspicuity of HCC [ 34 – 36 ]. However, it was not confirmed by iron-staining pathologic correlation.…”

Section: Discussionsupporting

confidence: 91%

Detection of Endogenous Iron Reduction during Hepatocarcinogenesis at Susceptibility-Weighted MR Imaging: Value for Characterization of Hepatocellular Carcinoma and Dysplastic Nodule in Cirrhotic Liver

Palmer

Zeng

et al. 2015

PLoS ONE

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ObjectiveTo investigate the value of susceptibility-weighted imaging (SWI) for characterization of hepatocellular carcinoma (HCC) and dysplastic nodule (DN).Materials and MethodsSixty-eight cirrhotic patients with 89 hepatocellular nodules underwent SWI. The radiological features of hepatocellular nodules on SWI were classified into three types: type A (iso- or hypointensity, and background liver siderosis), type B (hyperintensity, and background liver siderosis), or type C (hyperintensity, and no background liver siderosis). Intranodular and background liver iron content was quantified and correlated with SWI pattern. Prussian blue staining was performed to quantify intranodular and background liver iron content.ResultsType A pattern (n = 12) contained 11 (91.7%) DNs and 1 (8.3%) HCC, Type B pattern (n = 66) comprised 1 (1.5%) DN and 65 (98.5%) HCCs (including 12 DN-HCCs and 53 overt HCCs), and type C pattern (n = 11) was exclusively seen in HCCs. The iron scores of DN-HCCs and overt HCCs were significantly lower than those of background livers [(0.091±0.30) VS (2.18±0.87), P = 0.000; (0.11±0.41) VS (2.16±0.97), P = 0.000; respectively]. There was no significant difference between iron scores of DNs and those of background livers [(1.92±0.29) VS (2.17±039), P = 0.191]. For lesion-based and patient-based analysis of HCCs (DN-HCCs and overt HCCs), type B pattern showed a sensitivity, specificity, accuracy, positive predicative value (PPV), and negative predicative value (NPV) of 84.4% and 84.4%, 91.7% and 75%, 85.4% and 83.8%, 98.5% and 98.2%, 47.8% and 23.1%, respectively.ConclusionSWI can provide valuable information for characterization of HCC and DN based on endogenous iron reduction during hepatocarcinogenesis.

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Section: Discussionsupporting

confidence: 91%

Detection of Endogenous Iron Reduction during Hepatocarcinogenesis at Susceptibility-Weighted MR Imaging: Value for Characterization of Hepatocellular Carcinoma and Dysplastic Nodule in Cirrhotic Liver

Palmer

Zeng

et al. 2015

PLoS ONE

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“…In this study, the total examination time was about 10 minutes only. A previous study performed in the late 2000s reported modest sensitivity (52–55%) and high specificity (88–90%) of non-contrast MRIs compared to contrast-enhanced MRIs (sensitivity, 81–84%; specificity, 62–65%) in liver transplantation patients ( 28 ). However, according to Kim et al ( 10 ) in 2013, the sensitivity (91.2–95.1%) and specificity (66.7–79.4%) of non-contrast MRIs are comparable to those of contrast-enhanced MRI (sensitivity, 93.9–95.9%; specificity, 75.7–82.4%).…”

Section: Discussionmentioning

confidence: 98%

The Diagnostic Performance of Liver MRI without Intravenous Contrast for Detecting Hepatocellular Carcinoma: A Case-Controlled Feasibility Study

et al. 2018

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ObjectiveTo preliminarily evaluate the diagnostic performance of an unenhanced MRI for detecting hepatocellular carcinoma (HCC) with a case-control study design.Materials and MethodsThe case group consisted of 175 patients with initially-diagnosed HCC, who underwent a 3T liver MRI. A total of 237 HCCs were identified. The number of HCCs that were smaller than 1 cm, 1 cm ≤ and < 2 cm, and ≥ 2 cm were 19, 105, and 113, respectively. For the control group, 72 patients with chronic liver disease, who did not have HCC, were enrolled. Two radiologists independently reviewed the T2 half-Fourier acquisition single-shot turbo spin echo, T2 fast spin echos with fat saturation, T1 gradient in- and out-of-phase images, and diffusion-weighted images/apparent diffusion coefficient maps to detect HCC. Per-patient analyses were performed to evaluate the sensitivity and specificity of the non-contrast MRI for diagnosing HCC. Furthermore, the per-lesion sensitivity was also calculated according to tumor size.ResultsIn the per-patient analyses, the sensitivity and specificity of reader 1 were 86.3% (151/175) and 87.5% (63/72), respectively; while those of reader 2 were 82.9% (145/175) and 76.4% (55/72), respectively. When excluding HCCs smaller than 1 cm, the sensitivity of reader 1 and 2 were 88.0% (147/167) and 86.2% (144/167), respectively. In the per-lesion analyses, the sensitivities of reader 1 and reader 2 were 75.9% (180/237) and 70.5% (167/237), respectively.ConclusionThe per-patient sensitivity and specificity of non-contrast MRIs were within a reasonable range for the initial diagnosis of HCC. Non-contrast MRIs may have a potential for surveillance of HCC. Further confirmatory diagnostic test accuracy studies are needed.

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“…Hardie et al reported that non-contrast MRI has moderate sensitivity for HCC detection in transplanted liver compared to gadolinium-enhanced MRI (53.5% vs 82.5%), implying diagnostic value of non-contrast MRI when gadolinim cannot be administered. 23 In a study which analyzed patients who underwent surgical resection, Kim et al reported that the Az value of the non-contrast MRI (mean, 0.906) was not inferior to that of the gadoxetic acid-enhanced whole MRI (mean, 0.924) for detecting HCC and cholangiocarcinoma (p > 0.05). 24 The previous study 24 and our current study both demonstrated considerably high sensitivity of non-contrast MRI for detecting HCC (92.2-93.0% and 97.0%, respectively).…”

Section: Discussionmentioning

confidence: 99%

Detection of recurrent hepatocellular carcinoma after surgical resection: Non-contrast liver MR imaging with diffusion-weighted imaging versus gadoxetic acid-enhanced MR imaging

Min

Kim

Choi

et al. 2018

BJR

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Can the Patient With Cirrhosis Be Imaged for Hepatocellular Carcinoma Without Gadolinium?

Cited by 15 publications

References 12 publications

Detection of Endogenous Iron Reduction during Hepatocarcinogenesis at Susceptibility-Weighted MR Imaging: Value for Characterization of Hepatocellular Carcinoma and Dysplastic Nodule in Cirrhotic Liver

Detection of Endogenous Iron Reduction during Hepatocarcinogenesis at Susceptibility-Weighted MR Imaging: Value for Characterization of Hepatocellular Carcinoma and Dysplastic Nodule in Cirrhotic Liver

The Diagnostic Performance of Liver MRI without Intravenous Contrast for Detecting Hepatocellular Carcinoma: A Case-Controlled Feasibility Study

Detection of recurrent hepatocellular carcinoma after surgical resection: Non-contrast liver MR imaging with diffusion-weighted imaging versus gadoxetic acid-enhanced MR imaging

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