Hepatocellular carcinoma detection: diagnostic performance of a simulated abbreviated MRI protocol combining diffusion-weighted and T1-weighted imaging at the delayed phase post gadoxetic acid

Besa, Cecilia; Lewis, Sara; Pandharipande, Pari V.; Chhatwal, Jagpreet; Kamath, Amita; Cooper, Nancy; Knight‐Greenfield, Ashley; Babb, James S.; Boffetta, Paolo; Padrón, Norma A.; Sirlin, Claude B.; Taouli, Bachir

doi:10.1007/s00261-016-0841-5

Cited by 113 publications

(135 citation statements)

References 35 publications

Supporting

Mentioning

122

Contrasting

Unclassified

Order By: Relevance

“…Analysis of a simulated AMRI protocol from the complete image set yielded a mean per-patient sensitivity of 83% for HCC detection, with reduced cost compared to the standard. Another retrospective single-center study reported a per-patient sensitivity of 81% and per-lesion sensitivity of 78%, confirming the maintained sensitivity in the simplified protocol [34]. The estimated range of cost saving with AMRI was 31–49%.…”

Section: Experimental Hcc Surveillance Modalitiesmentioning

confidence: 63%

Tailored Algorithms for Hepatocellular Carcinoma Surveillance: Is One-Size-Fits-All Strategy Outdated?

Goossens

Bian

Hoshida

2017

Curr Hepatology Rep

View full text Add to dashboard Cite

Purpose of review Current clinical practice guidelines recommend regular hepatocellular carcinoma (HCC) surveillance with biannual ultrasound with or without serum alpha-fetoprotein uniformly applied to all patients with cirrhosis. However, clinical implementation of this one-size-fits-all strategy has been challenging as evidenced by very low application rate below 20% due to various reasons, including suboptimal performance of the surveillance modalities. Recent findings Newly emerging imaging techniques such as abbreviated MRI (AMRI) and molecular HCC risk biomarkers have increasingly become available for clinical evaluation and implementation. These technologies may have a potential to reshape HCC surveillance by enabling tailored strategies. This would involve performing optimized surveillance tests according to individual HCC risk, and allocating limited medical resources for HCC surveillance based on cost-effectiveness. Summary Tailored HCC surveillance could lead to achievement of precision HCC care and substantial improvement of the current dismal patient prognosis.

show abstract

Section: Experimental Hcc Surveillance Modalitiesmentioning

confidence: 63%

Tailored Algorithms for Hepatocellular Carcinoma Surveillance: Is One-Size-Fits-All Strategy Outdated?

Goossens

Bian

Hoshida

2017

Curr Hepatology Rep

View full text Add to dashboard Cite

show abstract

“…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.…”

Section: Computed Tomography and Magnetic Resonance Imagingmentioning

confidence: 99%

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

Mohammed

Roberts

2017

Curr Hepatology Rep

View full text Add to dashboard Cite

a) Purpose of review To address the controversy around the use of biomarkers for hepatocellular carcinoma (HCC) surveillance in individuals with cirrhosis or chronic hepatitis B who are at risk for development of liver cancer. b) Recent findings Recent studies suggest that surveillance for hepatocellular carcinoma is beneficial, even after adjustment for lead time and other biases. Alpha fetoprotein (AFP) is complementary to ultrasound (US) in surveillance, particularly in obese patients and patients with infiltrative tumors. US and AFP are both associated with harms to patients from false positive over-diagnosis, with US appearing to cause greater harms. Including patient demographic characteristics and additional biomarkers into diagnostic models is beneficial. Recent studies emphasize the advantage of time trends in biomarkers over single cross-sectional measurements. c) Summary AFP and other biomarkers are complementary to US in surveillance for HCC, especially when applied in models including patient variables and incorporating time trends in biomarker levels. With advances in genetic and molecular analysis of tumors, we may be poised at the cusp of a revolution in HCC surveillance.

show abstract

“…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 .…”

mentioning

confidence: 99%

“…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%

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

View full text Add to dashboard Cite

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.

show abstract

Hepatocellular carcinoma detection: diagnostic performance of a simulated abbreviated MRI protocol combining diffusion-weighted and T1-weighted imaging at the delayed phase post gadoxetic acid

Abstract: AMRI using DWI and T1w-HBP has a clinically acceptable sensitivity and NPV for HCC detection. This could serve as the basis for a future study assessing AMRI for HCC screening and surveillance.

Cited by 113 publications

References 35 publications

Tailored Algorithms for Hepatocellular Carcinoma Surveillance: Is One-Size-Fits-All Strategy Outdated?

Tailored Algorithms for Hepatocellular Carcinoma Surveillance: Is One-Size-Fits-All Strategy Outdated?

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

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

Contact Info

Product

Resources

About