Meta-Analysis of the Accuracy of Abbreviated Magnetic Resonance Imaging for Hepatocellular Carcinoma Surveillance: Non-Contrast versus Hepatobiliary Phase-Abbreviated Magnetic Resonance Imaging

Kim, Dong Hwan; Choi, Sang Hyun; Shim, Ju Hyun; Kim, So Yeon; Lee, Seung Soo; Byun, Jae Ho; Choi, Joon Weon

doi:10.3390/cancers13122975

Cited by 19 publications

(22 citation statements)

References 43 publications

(118 reference statements)

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“…NC-AMRI with or without in- and opposed-phase T1W imaging had non-significant differences in sensitivity and specificity [ 19 ]. In another meta-analysis, comparing hepatobiliary phase CE-AMRI and NC-MRI for detection of HCC, sensitivity was higher in favor of CE-MRI over NC-AMRI, but specificity was lower (sensitivity 87% vs. 82% and specificity 93% vs. 98%, respectively) [ 30 ]. However, some of the included studies in this review were not performed in a surveillance setting for HCC detection.…”

Section: Discussionmentioning

confidence: 99%

“…However, some of the included studies in this review were not performed in a surveillance setting for HCC detection. In spite of the fact that some limited differences in sensitivity and specificity between different AMRI protocols for surveillance of HCC were reported, the sensitivity and specificity are generally much better compared with US [ 3 , 7 , 9 , 13 , 19 , 25 , 26 , 27 , 29 , 30 , 31 ]. Furthermore, our results concur with these reports.…”

Section: Discussionmentioning

confidence: 99%

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Potential of a Non-Contrast-Enhanced Abbreviated MRI Screening Protocol (NC-AMRI) in High-Risk Patients under Surveillance for HCC

Willemssen

Sablonière

Bos

et al. 2022

Cancers

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Purpose: To evaluate NC-AMRI for the detection of HCC in high-risk patients. Methods: Patients who underwent yearly contrast-enhanced MRI (i.e., full MRI protocol) of the liver were included retrospectively. For all patients, the sequences that constitute the NC-AMRI protocol, namely diffusion-weighted imaging (DWI), T2-weighted (T2W) imaging with fat saturation, and T1-weighted (T1W) in-phase and opposed-phase imaging, were extracted, anonymized, and uploaded to a separate research server and reviewed independently by three radiologists with different levels of experience. Reader I and III held a mutual training session. Levels of suspicion of HCC per patient were compared and the sensitivity, specificity, and area under the curve (AUC) using the Mann–Whitney U test were calculated. The reference standard was a final diagnosis based on full liver MRI and clinical follow-up information. Results: Two-hundred-and-fifteen patients were included, 36 (16.7%) had HCC and 179 (83.3%) did not. The level of agreement between readers was reasonable to good and concordant with the level of expertise and participation in a mutual training session. Receiver operating characteristics (ROC) analysis showed relatively high AUC values (range 0.89–0.94). Double reading showed increased sensitivity of 97.2% and specificity of 87.2% compared with individual results (sensitivity 80.1%–91.7%–97.2%; specificity 91.1%–72.1%–82.1%). Only one HCC (2.8%) was missed by all readers. Conclusion: NC-AMRI presents a good potential surveillance imaging tool for the detection of HCC in high-risk patients. The best results are achieved with two observers after a mutual training session.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Potential of a Non-Contrast-Enhanced Abbreviated MRI Screening Protocol (NC-AMRI) in High-Risk Patients under Surveillance for HCC

Willemssen

Sablonière

Bos

et al. 2022

Cancers

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“…The previous meta-analysis revealed that the pooled sensitivity and specificity were 0.86-0.87 and 0.94-0.96, respectively, with an AUROC of 0.95 for the detection of HCC using gadoxetic acid abbreviated MRI. 82,83 Another meta-analysis of gadoxetic acid abbreviated MRI reported an excellent inter-reader agreement (κ = 0.98) for the detection of HCC. 84 Few papers have examined the usefulness of abbreviated MRI for searching liver metastases.…”

Section: Clinical Significance Of Liver Mrimentioning

confidence: 99%

Clinical Significance of Liver MR Imaging

Ichikawa

Goshima

2023

magn reson med sci

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MRI is widely used in clinical practice for detecting liver diseases. Since the introduction of gadoxetic acid, MRI has become the most effective modality for the detection and characterization of focal liver lesions. According to previous meta-analyses, the area under the receiver operating characteristic curve (AUROC) was 0.97–0.99 for the diagnosis of small hepatocellular carcinoma (≥ 2 cm) by gadoxetic-acid-enhanced MRI. Moreover, the AUROC for the diagnosis of colorectal liver metastases was significantly high (0.98). Despite gadoxetic acid’s drawbacks, its clinical utility outweighs them, making it the contrast agent of choice in routine liver MRIs. Moreover, clinically, liver MRI has become more prevalent for a quantitative assessment. Liver fibrosis can be evaluated using MR elastography; whereas, hepatic steatosis and iron overload can be evaluated using proton density fat fraction, with high accuracy and reproducibility. This article reviewed the usefulness of liver MRI, which can be a comprehensive imaging modality in clinical practice.

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“…[223] To leverage the performance of MRI with limited costs and procedural requirements, abbreviated MRI (AMRI) has been actively explored to develop a protocol tailored as an HCC screening test. [224,225] AMRI protocols can be classified into three types: noncontrast-enhanced, hepatobiliary contrast-enhanced, and dynamic extracellular contrast-enhanced AMRI. [226] The overall patient-level sensitivity and specificity of AMRI for HCC detection were 86% and 94%, respectively, in a meta-analysis, regardless of the AMRI type, presence of cirrhosis, and HCC etiology.…”

Section: Imaging-based Hcc Early-detection Testsmentioning

confidence: 99%

Risk stratification and early detection biomarkers for precision HCC screening

et al. 2022

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Hepatocellular carcinoma (HCC) mortality remains high primarily due to late diagnosis as a consequence of failed early detection. Professional societies recommend semi-annual HCC screening in at-risk patients with chronic liver disease to increase the likelihood of curative treatment receipt and improve survival. However, recent dynamic shift of HCC etiologies from viral to metabolic liver diseases has significantly increased the potential target population for the screening, whereas annual incidence rate has become substantially lower. Thus, with the contemporary HCC etiologies, the traditional screening approach might not be practical and cost-effective. HCC screening consists of (i) definition of rational at-risk population, and subsequent (ii) repeated application of early detection tests to the population at regular intervals. The suboptimal performance of the currently available HCC screening tests highlights an urgent need for new modalities and strategies to improve early HCC detection. In this review, we overview recent developments of clinical, molecular, and imaging-based tools to address the current challenge, and discuss conceptual framework and approaches of their clinical translation and implementation. These encouraging progresses are expected to transform the current "one-size-fits-all" HCC screening into

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Meta-Analysis of the Accuracy of Abbreviated Magnetic Resonance Imaging for Hepatocellular Carcinoma Surveillance: Non-Contrast versus Hepatobiliary Phase-Abbreviated Magnetic Resonance Imaging

Cited by 19 publications

References 43 publications

Potential of a Non-Contrast-Enhanced Abbreviated MRI Screening Protocol (NC-AMRI) in High-Risk Patients under Surveillance for HCC

Potential of a Non-Contrast-Enhanced Abbreviated MRI Screening Protocol (NC-AMRI) in High-Risk Patients under Surveillance for HCC

Clinical Significance of Liver MR Imaging

Risk stratification and early detection biomarkers for precision HCC screening

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