Diagnostic per-lesion performance of a simulated gadoxetate disodium-enhanced abbreviated MRI protocol for hepatocellular carcinoma screening

Tillman, B.G.; Gorman, Jason J.; Hru, J.M.; Lee, M.H.; King, M.C.; Sirlin, Claude B.; Marks, Robert M.

doi:10.1016/j.crad.2017.11.013

Cited by 66 publications

(73 citation statements)

References 30 publications

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“…AMRI can be primarily divided into three categories (Table 1): noncontrast AMRI, HBP added to noncontrast AMRI (EOB-AMRI), and dynamic AMRI using an ECCM. [19][20][21][22][23] In prior studies, two to five key sequences were selected for each AMRI protocol to yield a fairly high per-patient sensitivity of 80-89.6% for the diagnosis of HCC. [19][20][21][22][23][24] Particularly, for noncontrast AMRI, the perpatient sensitivity and specificity ranged from 82.9-89.6%…”

Section: Abbreviated Liver Mri (Amri): Suggested Sequences and Diagnomentioning

confidence: 99%

Liver Magnetic Resonance Imaging for Hepatocellular Carcinoma Surveillance

Kim¹

2020

J Liver Cancer

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Hepatocellular carcinoma (HCC) surveillance is recommended when the annual incidence of HCC exceeds 1.5%. In 2018, several international guidelines included alternative surveillance modalities, such as computed tomography and magnetic resonance imaging (MRI), as alternatives for patients with inadequate surveillance with an ultrasound. Currently, abbreviated MRI selectively includes several key sequences and is emerging as an effective tool for HCC surveillance with reduced cost and scan time and the required diagnostic performance. The incidence of HCC substantially impacts the benefits of surveillance in terms of cost-effectiveness. Therefore, we need to individualize imaging surveillance of HCC, tailor screening, and determine risk-stratified strategies. The purpose of this article was to present a brief overview of the diagnostic performance and cost-effectiveness of liver MRI as an HCC surveillance tool. (J Liver Cancer 2020;20:25-31)

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Section: Abbreviated Liver Mri (Amri): Suggested Sequences and Diagnomentioning

confidence: 99%

Liver Magnetic Resonance Imaging for Hepatocellular Carcinoma Surveillance

Kim¹

2020

J Liver Cancer

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“…Accordingly, several investigators have explored various aMRI strategies for HCC screening in patients with cirrhosis, including those based on unenhanced T 1 ‐ and T 2 ‐weighted and diffusion‐weighted imaging, hepatobiliary phase imaging with hepatocyte‐specific GBCA, as well as those based on DCE imaging with extracellular GBCA . The latter strategy, referred to as dynamic aMRI in contradistinction to unenhanced and hepatobiliary aMRI, is appealing because LI‐RADS major features (arterial phase hyperenhancement, venous‐phase washout, and enhancing capsule) for HCC diagnosis are based exclusively on DCE imaging, and thus dynamic aMRI may permit both detection (screening), characterization (diagnosis), and staging in a single examination.…”

mentioning

confidence: 99%

“…[17][18][19] Previous models have shown that a complete-protocol diagnostic MRI is not costeffective for screening of the cirrhosis population. 20 However, if the MRI exam time can be shortened and its cost reduced while maintaining its accuracy, an abbreviated MRI (aMRI) screening strategy may prove to be a cost-effective alternative in the U.S. 21 Accordingly, several investigators have explored various aMRI strategies for HCC screening in patients with cirrhosis, including those based on unenhanced T 1 -and T 2 -weighted and diffusion-weighted imaging, 22 hepatobiliary phase imaging with hepatocyte-specific GBCA, 18,23,24 as well as those based on DCE imaging with extracellular GBCA. 25,26 The latter strategy, referred to as dynamic aMRI in contradistinction to unenhanced and hepatobiliary aMRI, is appealing because LI-RADS major features (arterial phase hyperenhancement, venous-phase washout, and enhancing capsule) for HCC diagnosis are based exclusively on DCE imaging, and thus dynamic aMRI may permit both detection (screening), characterization (diagnosis), and staging in a single examination.…”

mentioning

confidence: 99%

Abbreviated‐protocol screening MRI vs. complete‐protocol diagnostic MRI for detection of hepatocellular carcinoma in patients with cirrhosis: An equivalence study using LI‐RADS v2018

Khatri

Pedrosa

Ananthakrishnan

et al. 2019

Magnetic Resonance Imaging

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Background The high operational cost of MRI limits its utility for hepatocellular carcinoma (HCC) screening. Abbreviated‐protocol dynamic contrast‐enhanced MRI (aMRI) may help lower cost while maintaining the high accuracy of complete‐protocol diagnostic MRI (cMRI). Purpose To compare aMRI to cMRI for HCC detection in cirrhosis patients. Study Type Cross‐sectional study. Study Population Cirrhosis patients undergoing MRI for suspected HCC. Field Strength/Sequence 1.5T and 3T; aMRI (coronal T2‐weighted, axial dynamic contrast‐enhanced T1‐weighted fat‐suppressed sequences); cMRI (aMRI sequences and unenhanced axial T2‐, T1‐, and diffusion‐weighted sequences). Assessment From each cMRI, an abbreviated exam was created by extracting only the aMRI sequences. Five radiologists independently reviewed aMRI and cMRI and assigned per‐patient screening results by the presence/absence of any actionable observation per Liver Imaging and Reporting Data System v2018 (LI‐RADS 4, 5, M, or TIV categories). Per‐patient HCC status was determined by the composite reference standard of histopathology, follow‐up imaging, consensus expert panel imaging review, and clinical follow‐up. Statistical Tests Interreader agreement between aMRI and cMRI was compared with that of cMRI and tested for interchangeability against a tolerance margin of 0.05. Per‐patient screening sensitivity, specificity, and accuracy were compared between aMRI and cMRI and tested for equivalence against a tolerance margin of 0.05. Results In 93 cirrhosis patients, five radiologists recorded on average 121 liver observations. Interreader screening agreement probability (and 95% confidence interval confidence interval [CI]) was 0.914 [0.900, 0.926] between aMRI and cMRI, and 0.927 [0.908, 0.942] for cMRI; their difference was within the 0.05 margin for interchangeability. In 86 patients in whom a final HCC status could be determined, the detection sensitivity and specificity of aMRI was 0.921 [0.864, 0.956] and 0.886 [0.844, 0.918], within the 5% equivalence margin to cMRI, 0.936 [0.881, 0.965] and 0.883 [0.840, 0.915], respectively. Data Conclusion Abbreviated‐protocol screening MRI is interchangeable with, and equivalent to, complete‐protocol diagnostic MRI for per‐patient HCC detection in cirrhosis. Level of Evidence: 4 Technical Efficacy: Stage 6 J. Magn. Reson. Imaging 2020;51:415–425.

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“…The abbreviated MRI exam has been embraced in the radiology community as an important and valuable initiative. Current studies focusing on the role of MRI in screening and surveillance have developed specialized protocols that are often abbreviated with applications in the prostate and liver . Variable imaging protocols have been used and in general show a similar diagnostic performance compared with the full protocol for the detection of occult malignancies.…”

Section: Abbreviated Mri As a Valuable Initiativementioning

confidence: 99%

“…Current studies focusing on the role of MRI in screening and surveillance have developed specialized protocols that are often abbreviated with applications in the prostate and liver. [85][86][87][88][89][90][91][92] Variable imaging protocols have been used and in general show a similar diagnostic performance compared with the full protocol for the detection of occult malignancies. Other novel applications include using abbreviated MRI in the pediatric population to decrease the duration of necessary sedation, and as a rapid and accurate imaging tool in the musculoskeletal setting to detect fractures and increase patient throughput in an emergency setting.…”

Section: Abbreviated Mri As a Valuable Initiativementioning

confidence: 99%