Multicenter Validation of Abbreviated MRI for Detecting Early-Stage                     Hepatocellular Carcinoma

Yokoo, Takeshi; Masaki, Nobuaki; Parikh, Neehar D.; Lane, Barton; Feng, Ziding; Mendiratta‐Lala, Mishal; Lee, Chee Hwee; Khatri, Gaurav; Marsh, Tracey; Shetty, Kirti; Dunn, Colin; Al-Jarrah, Taim; Aslam, Anum; Davenport, Matthew S.; Gopal, Purva; Rich, Nicole E.; Lok, Anna S.; Singal, Amit G.

doi:10.1148/radiol.220917

Cited by 29 publications

(13 citation statements)

References 31 publications

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“…Although ultrasound with or without AFP is the current standard surveillance strategy, there are several emerging blood and imaging-based modalities that are being proposed. [48][49][50][51][52][53][54][55][56] It is possible that physical, financial, and psychological harms may differ by modality, so studies evaluating the clinical utility of these emerging modalities should measure both surveillance benefits and harms. [35,57,58] Although we used a set of validated surveys, future studies may consider adding alternative measures of psychological harms, such as the original Consequences of Screening Questionnaire.…”

Section: Discussionmentioning

confidence: 99%

Hepatocellular carcinoma surveillance may be associated with potential psychological harms in patients with cirrhosis

Narasimman¹,

Hernáez

Cerda

et al. 2023

Hepatology

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Background and Aims: The value of HCC surveillance is determined by the balance between benefits and harms; however, no studies have enumerated psychological harms. Approach and Results: We fielded surveys measuring psychological harms to patients with cirrhosis in a multicenter randomized trial of HCC surveillance outreach. All patients with positive or indeterminate surveillance results and matched patients with negative results were invited to complete surveys measuring (1) depression through the Patient Health Questionnaire-ninth version, (2) anxiety through State-Trait Anxiety Inventory, (3) HCC-specific worry through Psychological Consequences Questionnaire, and (4) decisional regret. Patients were classified into 4 groups: true positive (TP), false positive (FP), indeterminate, and true negative (TN). Multivariable longitudinal regression analysis using the generalized estimating equation method was performed to compare the means of measures across groups. We conducted 89 semistructured interviews in a subset of patients stratified by health system and test results. Of 2872 patients in the trial, 311 completed 1+ follow-up survey (63 FP, 77 indeterminate, 38 TP, and 133 TN). Moderate depression decreased in TN patients, increased in TP, and had intermittent but mild increases in those with FP and indeterminate results. High anxiety temporarily increased in patients with TP results but resolved over time and was stable in those with FP and indeterminate results. Decisional regret was low and did not differ across groups. In semistructured interviews, patients reported apprehension, anxiety, emotional distress, and coping related to HCC surveillance. Conclusions: Psychological harms of HCC surveillance appear mild but differ by test result. Future research should determine the impact of psychological harms on the value of HCC surveillance programs.

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Section: Discussionmentioning

confidence: 99%

Hepatocellular carcinoma surveillance may be associated with potential psychological harms in patients with cirrhosis

Narasimman¹,

Hernáez

Cerda

et al. 2023

Hepatology

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“…The present study demonstrated that A-MRI showed comparable performance in detecting small HCC compared to full sequence Gd-EOB-DTPA-enhanced MRI by using A-MRI diagnostic criteria of HBP hypointensity plus at least one ancillary feature (T2WI mild to moderate hyperintensity and/or restricted diffusion). A recent multicenter study found that dynamic abbreviated MRI protocols had high sensitivity and specificity for early-stage HCC detection based on Milan criteria using pathological confirmation (19). However, in the present study, there were no significant differences in sensitivities and specificities between the two protocols and a higher diagnostic accuracy was observed for the F-MRI protocol, which was a result of the dynamic phase allowing for more accurate diagnosis of benign lesions such as dysplastic nodules with T2WI hyperintensity or restricted DWI.…”

Section: Discussionmentioning

confidence: 99%

“…In the included 204 patients, 71 benign lesions including 21 hemangioma, 27 low-grade dysplastic nodules (LGDNs), 10 high-grade dysplastic nodules (HGDNs), six regenerative nodules and seven intrahepatic arterioportal shunts were identified. Out of 71 benign lesions, 29 DNs (10 HGDNs and 19 LGDNs) were confirmed pathologically and 41 benign lesions were identified by 12-month follow-up imaging studies.…”

Section: The Characteristics Of Patients and Liver Lesionsmentioning

confidence: 97%

“…Although hepatocytespecific gadoxetic acid (Gd-EOB-DTPA)-enhanced MRI represents higher sensitivity in detecting small or earlystage HCC (13), a longer scanning time and higher cost of MRI protocol impede its use in HCC surveillance. Recently, abbreviated MRI (A-MRI) protocols consisting of shortened protocols have been evaluated as alternative methods for liver malignancy screening and provided a lower cost of MRI, higher sensitivity and decreased image assessment complexity (14)(15)(16)(17)(18)(19). However, most experts considered that more evidence is needed to support A-MRI for Gd-EOB-DTPA-enhanced MRI for HCC screening and surveillance (20), mainly because of a lack of early dynamic enhancement, especially for the arterial phase.…”

Section: Introductionmentioning

confidence: 99%

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Diagnostic performance of gadoxetic acid-enhanced abbreviated magnetic resonance imaging protocol in small hepatocellular carcinoma (≤2 cm) in high-risk patients

Wang,

Qiu,

Dong

et al. 2023

Acta Radiol

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Background Biannual Ultrasound showed insufficient sensitivity in detecting small or early-stage hepatocellular carcinoma (HCC). Abbreviated magnetic resonance imaging (A-MRI) protocols with fewer sequences demonstrated higher HCC detection sensitivity than ultrasound with acceptable cost and examination time. Purpose To compare the diagnostic performance of gadoxetic acid-enhanced A-MRI with a full sequence MRI (F-MRI) protocol for small HCC (≤2 cm) in cirrhotic or hepatitis B virus-infected high-risk patients. Material and Methods Two hundred and four consecutive patients with 166 pathologically confirmed small HCC who underwent preoperative gadoxetic acid-enhanced MRI were retrospectively included. A-MRI set comprised T1-weighted hepatobiliary phase imaging, T2-weighted imaging, diffusion-weighted imaging and apparent diffusion coefficient mapping. Two independent radiologists blinded to clinical data assessed the A-MRI set and F-MRI set. Per-patient HCC and per-lesion HCC diagnostic performance were compared. Results Per-patient HCC detection sensitivity of A-MRI set was 93.8% and 91.2% for observer 1 and observer 2, and, for the F-MRI set, the per-patient HCC detection sensitivity was 96.6% and 95.2%, respectively. There was no significant difference in per-patient sensitivity, specificity and per-lesion HCC detection sensitivity between the two imaging sets for both readers. ( P = 0.06–0.25) The A-MRI set showed higher sensitivity on HCC without arterial phase hyperenhancement, and the F-MRI set demonstrated with higher sensitivity on HCC with arterial phase hyperenhancement ( P < 0.05). Conclusion A-MRI using diagnostic criteria including hypointensity on hepatobiliary phase plus mild to moderate hyperintensity on T2-weighted imaging or restricted diffusion demonstrated comparable sensitivity and specificity for small HCC compared to the F-MRI protocol in high-risk patients.

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“…Abbreviated MRI has been proposed as a means of reducing in-scanner time and costs. Case-control data suggest preserved sensitivity and specificity compared to full diagnostic MRI, with preserved data in patients with NASH cirrhosis; [65][66][67] however, prospective validation is needed.…”

Section: Surveillancementioning

confidence: 99%

Non-alcoholic fatty liver disease-related hepatocellular carcinoma

Daher

Dahan

Singal³

2023

JLC

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Non-alcoholic fatty liver disease (NAFLD), one of the most common causes of liver disease, is an increasingly common cause of hepatocellular carcinoma (HCC). Several demographic, clinical, and genetic factors contribute to HCC risk in NAFLD patients, which may inform risk stratification scores. Proven efficacious approaches to primary prevention approach in patients with non-viral liver disease remain an area of need. Semi-annual surveillance is associated with improved early tumor detection and reduced HCC-related mortality; however, patients with NAFLD have several challenges to effective surveillance, including under-recognition of at-risk patients, low surveillance utilization in clinical practice, and lower sensitivity of current tools for early-stage HCC detection. Treatment decisions are best made in a multidisciplinary fashion and are informed by several factors including tumor burden, liver dysfunction, performance status, and patient preferences. Although patients with NAFLD often have larger tumor burden and increased comorbidities compared to counterparts, they can achieve similar post-treatment survival with careful patient selection. Therefore, surgical therapies continue to provide a curative treatment option for patients diagnosed at an early stage. Although there has been debate about the efficacy of immune checkpoint inhibitors in patients with NAFLD, current data are insufficient to change treatment selection based on liver disease etiology.

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Multicenter Validation of Abbreviated MRI for Detecting Early-Stage Hepatocellular Carcinoma

Cited by 29 publications

References 31 publications

Hepatocellular carcinoma surveillance may be associated with potential psychological harms in patients with cirrhosis

Hepatocellular carcinoma surveillance may be associated with potential psychological harms in patients with cirrhosis

Diagnostic performance of gadoxetic acid-enhanced abbreviated magnetic resonance imaging protocol in small hepatocellular carcinoma (≤2 cm) in high-risk patients

Non-alcoholic fatty liver disease-related hepatocellular carcinoma

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