Diagnostic Per-Patient Accuracy of an Abbreviated Hepatobiliary Phase Gadoxetic Acid–Enhanced MRI for Hepatocellular Carcinoma Surveillance

Abstract

OBJECTIVE. The purpose of this study is to evaluate the per-patient diagnostic performance of an abbreviated gadoxetic acid-enhanced MRI protocol for hepatocellular carcinoma (HCC) surveillance. MATERIALS AND METHODS. A retrospective review identified 298 consecutive patients at risk for HCC enrolled in a gadoxetic acid-enhanced MRI-based HCC surveillance program. For each patient, the first gadoxetic acid-enhanced MRI was analyzed. To simulate an abbreviated protocol, two readers independently read two image sets per patient: set 1 consisted of T1-weighted 20-minute hepatobiliary phase and T2-weighted single-shot fast spin-echo (SSFSE) images; set 2 included diffusion-weighted imaging (DWI) and images from set 1. Image sets were scored as positive or negative according to the presence of at least one nodule 10 mm or larger that met the predetermined criteria. Agreement was assessed using Cohen kappa statistics. A composite reference standard was used to determine the diagnostic performance of each image set for each reader. RESULTS. Interreader agreement was substantial for both image sets (κ = 0.72 for both) and intrareader agreement was excellent (κ = 0.97-0.99). Reader performance for image set 1 was sensitivity of 85.7% for reader A and 79.6% for reader B, specificity of 91.2% for reader A and 95.2% for reader B, and negative predictive value of 97.0% for reader A and 96.0% for reader B. Reader performance for image set 2 was nearly identical, with only one of 298 examinations scored differently on image set 2 compared with set 1. CONCLUSION. An abbreviated MRI protocol consisting of T2-weighted SSFSE and gadoxetic acid-enhanced hepatobiliary phase has high negative predictive value and may be an acceptable method for HCC surveillance. The inclusion of a DWI sequence did not significantly alter the diagnostic performance of the abbreviated protocol.

Cost-Effectiveness of Risk Score–Stratified Hepatocellular Carcinoma Screening in Patients with Cirrhosis

“…9 The reference strategy was compared with two non-risk-stratified screening strategies: (1) biannual dynamic contrast-enhanced triple-phase MRI (full MRI) with 100% utilization rate (MRI2 × -100%); (2) biannual abbreviated contrast-enhanced MRI (AMRI) 17, 18 with 100% utilization rate (AMRI2 × -100%), and 14 risk-stratified strategies with various combinations of screening modalities assigned for each risk subgroup (Table 2). In each of the risk-stratified strategies, patients were first stratified into high-, intermediate-, and low-risk groups by applying either of the two integrated molecular and clinical HCC risk scores discussed in the next section.…”

Should AFP (or Any Biomarkers) Be Used for HCC Surveillance?

“…In an effort to maximize the potential value of cross-sectional MRI while minimizing contrast exposure, scanning time, and cost, abbreviated MRI examination protocols are being developed and tested in a number of centers [27, 28, 30, 52]. Ongoing studies may clarify the most appropriate niche for cost effective use of these modalities, perhaps particularly in those settings where US performs the least reliably, such as in individuals with truncal obesity.…”

“…In addition, recent advances in next generation sequencing and molecular analysis of tumors, blood, stool and other analytes are producing what potentially may prove to be very exciting breakthroughs in biomarker technology, particularly assays of differentially methylated DNA regions and microRNAs. In parallel, we are seeing advances in imaging technology, such as studies of limited MRI exams performed using hepatobiliary contrast agents, and the development of novel ultrasound-based technologies [27–30]. These newer modalities may provide substantial advances over current US screening at similar or reduced cost.…”

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

“…Specifically, the long examination times, limited scanner access, and high exam cost associated with MRI are considered prohibitive for routine screening. Complete‐protocol diagnostic liver MRI (cMRI) as recommended by LI‐RADS can require ~40 minutes of "room time" (including patient preparation, image acquisition, room turnover) during which a series of noncontrast sequences (T 2 ‐weighted, T 1 ‐weighted in‐ and opposed‐phase, diffusion‐weighted) are performed followed by DCE sequences before and after intravenous gadolinium‐based contrast agent (GBCA) injection . Previous models have shown that a complete‐protocol diagnostic MRI is not cost‐effective for screening of the cirrhosis population .…”