Evaluation of an abbreviated screening MRI protocol for patients at risk for hepatocellular carcinoma

Lee, Jennifer Y.; Huo, Eugene; Weinstein, Stefanie; Santos, Charmaine; Monto, Alexander; Corvera, Carlos U.; Yee, Judy; Hope, Thomas A.

doi:10.1007/s00261-017-1339-5

Cited by 59 publications

(63 citation statements)

References 13 publications

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“…Detection and characterization of liver observations per LI‐RADS algorithm primarily depends on the pulse sequences included in our dynamic aMRI protocol (a T 2 ‐weighted sequence followed by DCE sequences), allowing for the evaluation of all major features as well as some ancillary features. While it is possible that dynamic aMRI may not detect all potentially actionable observations (ie, LR‐4, 5, M, or TIV) or misclassify LR‐categories due to lack of ancillary features only obtainable through unenhanced sequences, a previous study found infrequent LR category adjustment between the initial aMRI and subsequent cMRI readings . Similarly, additional observations found only on cMRI (ie, missed by aMRI) were uncommon .…”

Section: Discussionmentioning

confidence: 95%

“…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.…”

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confidence: 99%

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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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Section: Discussionmentioning

confidence: 95%

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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“…They did not find any difference for liver reporting imaging and data system (LI‐RADS) categorization between the abbreviated and the full MRI protocols in 93%‐96%. The estimated time to run this abbreviated MRI was approximately 7‐10 minutes …”

Section: What's New For Screening Malignant Liver Tumours?mentioning

confidence: 99%

“…The estimated time to run this abbreviated MRI was approximately 7-10 minutes. 7 In summary, this is a very interesting topic and abbreviated MRI will probably play a greater role as a surveillance tool in patients at risk of HCC. Whether it will be used in all patients as a first-line surveillance tool or in patients in whom US is difficult such as those with metabolic syndrome or very high risk patients, will be discussed in the future.…”

Section: Hepatocellular Carcinomamentioning

confidence: 99%

Imaging of liver tumours: What’s new?

Vilgrain

Raynaud

Paulatto

et al. 2020

Liver International

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Liver tumours are very common and malignant tumours represent a major cause of cancer‐related death. Imaging plays an important role at many different stages of the care pathway. This review discusses new aspects and new roles for imaging and for MRI, in particular. MRI is already the best tool for the characterization and staging of benign and malignant liver tumours and it could also become a useful screening tool, especially for hepatocellular carcinoma. Liver imaging will be increasingly quantitative in the future, integrating new approaches such as those of artificial intelligence.

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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%