Noninvasive diagnosis of hepatocellular carcinoma on gadoxetic acid-enhanced MRI: can hypointensity on the hepatobiliary phase be used as an alternative to washout?

Joo, Ijin; Lee, Jeong Min; Lee, Dong Hoon; Jeon, Ju Hyeon; Han, Joon Koo; Choi, Byung Ihn

doi:10.1007/s00330-015-3686-3

Cited by 127 publications

(112 citation statements)

References 52 publications

(56 reference statements)

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“…For these reasons, transitional phase hypointensity is not specific for HCC, even in combination with APHE, and it can be seen with hemangiomas, non-HCC malignancies, some dysplastic nodules, siderotic nodules, and other benign entities. A recent study confirmed that transitional phase hypointensity can lead to false-positive interpretations and hence lower specificity for the diagnosis of HCC (77). Given its lack of specificity, transitional phase hypointensity does not have the same diagnostic implication as "washout" and does not constitute a major feature in LI-RADS.…”

Section: Capsule Appearancementioning

confidence: 80%

“…Although some studies have shown that transitional phase hypointensity is strongly predictive of HCCs (75)(76)(77), LI-RADS requires that "washout" after gadoxetate disodium injection be assessed in the portal venous phase, prior to the transitional or hepatobiliary phases. Due to rapid uptake of the agent by background hepatocytes, the liver is substantially enhanced in the transitional and hepatobiliary phases.…”

Section: Washout Appearancementioning

confidence: 99%

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Evidence Supporting LI-RADS Major Features for CT- and MR Imaging–based Diagnosis of Hepatocellular Carcinoma: A Systematic Review

et al. 2018

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The Liver Imaging Reporting and Data System (LI-RADS) standardizes the interpretation, reporting, and data collection for imaging examinations in patients at risk for hepatocellular carcinoma (HCC). It assigns category codes reflecting relative probability of HCC to imaging-detected liver observations based on major and ancillary imaging features. LI-RADS also includes imaging features suggesting malignancy other than HCC. Supported and endorsed by the American College of Radiology (ACR), the system has been developed by a committee of radiologists, hepatologists, pathologists, surgeons, lexicon experts, and ACR staff, with input from the American Association for the Study of Liver Diseases and the Organ Procurement Transplantation Network/United Network for Organ Sharing. Development of LI-RADS has been based on literature review, expert opinion, rounds of testing and iteration, and feedback from users. This article summarizes and assesses the quality of evidence supporting each LI-RADS major feature for diagnosis of HCC, as well as of the LI-RADS imaging features suggesting malignancy other than HCC. Based on the evidence, recommendations are provided for or against their continued inclusion in LI-RADS.q RSNA, 2017 Online supplemental material is available for this article.An Tang REVIEW: LI-RADS Major Features for Hepatocellular Carcinoma DiagnosisTang et al selection of five major features was based on expert opinion, the literature review was performed to ensure that imaging-based diagnostic criteria were able to achieve near-100% specificity for the noninvasive diagnosis of HCC. This review focused on the evidence supporting the inclusion of imaging features and did not attempt to gather evidence on the composition of the LI-RADS diagnostic algorithm and probability of HCC for different combinations of criteria (other than the hallmark combination of APHE and washout appearance) in the LI-RADS diagnostic table.Each subgroup was charged with developing key research questions and then critically reviewing the literature to answer research questions thematically related to its assigned topic. Search StrategyThe PICO (patient population, intervention, comparison, and outcome) format frequently used in structured reviews does not lend itself well to studies of diagnostic performance. Rather than using PICO-style questions to guide the searches, therefore, the subgroups formulated free-form questions in advance with feedback from the other subgroups. A total of 10 questions were formulated under the framework and with the understanding that their answers would inform recommendations for removing or continuing to include the corresponding LI-RADS features. After the questions were formulated, each subgroup searched the PubMed develop a standardized Liver Imaging Reporting and Data System (LI-RADS) for interpretation, reporting, and data collection of imaging studies in patients at risk for developing HCC (1). The committee was composed mainly of diagnostic radiologists, but also hepatologists, surgeons, patho...

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Section: Capsule Appearancementioning

confidence: 80%

Section: Washout Appearancementioning

confidence: 99%

Evidence Supporting LI-RADS Major Features for CT- and MR Imaging–based Diagnosis of Hepatocellular Carcinoma: A Systematic Review

et al. 2018

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“…Furthermore, several studies have shown that the addition of hypointensity on the TP or HBP to the noninvasive diagnostic criteria may increase the diagnostic performance of Gd-EOB-MRI for small HCCs including subcentimeter lesions. However, there have been concerns regarding the lowering of specificity caused by difficulty in observing the enhancement pattern or signal intensity on T2-weighted imaging of subcentimeter sized, non-HCC lesions [27,29,30,47]. Moreover, it has been shown that a combination of Gd-EOB-MRI and diffusion-weighted imaging (DWI) provides even higher diagnostic sensitivity in the detection of small HCCs than Gd-EOB-MRI or DWI alone [48,49].…”

Section: Small Hccmentioning

confidence: 99%

“…These differences in the included phase(s) for assessing "washout" between guidelines may have been derived from the different preferences for either higher sensitivity or higher specificity of a Gd-EOB-MRI diagnosis of HCC. As an example, when hypointensity on the TP and/or HBP is used as an alternative to "washout", the sensitivity for the diagnosis of HCC is increased, which may be appropriate in situations in which a high detection rate is preferred [27][28][29][30] (fig. 1).…”

Section: Gadoxetic Acid-enhanced Mri In the Current Practice Guidelinmentioning

confidence: 99%

“…1). To the contrary, if a specific diagnosis of HCC is preferred, "washout" should be determined on the PVP alone because malignant lesions other than HCCs, such as intrahepatic cholangiocarcinomas (ICCs) as well as some benign lesions such as hemangioma, can show hypointensity on the TP and/or HBP [27,31,32] (figs. 1 and 2).…”

Section: Gadoxetic Acid-enhanced Mri In the Current Practice Guidelinmentioning

confidence: 99%

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Recent Advances in the Imaging Diagnosis of Hepatocellular Carcinoma: Value of Gadoxetic Acid-Enhanced MRI

Joo

Lee

2015

Liver Cancer

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Magnetic resonance imaging (MRI) using gadolinium ethoxybenzyl diethylenetriamine pentaacetic acid (Gd-EOB-DPTA), or gadoxetic acid for short, is a hepatocyte-specific contrast agent which is now increasingly used for the detection and characterization of focal hepatic lesions, particularly in patients at high-risk of developing hepatocellular carcinomas (HCC). In fact, several recent guidelines now recognize gadoxetic acid-enhanced MRI (Gd-EOB-MRI) as the primary diagnostic imaging modality for the noninvasive diagnosis of HCC, although it must be noted that several major guidelines still include only extracellular contrast media-enhanced computed tomography and MRI. The primary merits of Gd-EOB-MRI lie in the fact that it can provide not only dynamic imaging, but also hepatobiliary phase (HBP) imaging which can lead to high lesion-to-liver contrast and give additional information regarding hepatocyte uptake via organic anion transporting polypeptides. This, in turn, allows higher sensitivity in detecting small HCCs and helps provide additional information regarding the multistep process of hepatocarcinogenesis. Indeed, many recent studies have investigated the diagnostic value of Gd-EOB-MRI for early HCCs as well as its role as a potential imaging biomarker in predicting outcome. We herein review the recent advances in the imaging diagnosis of HCCs focusing on the applications of Gd-EOB-MRI and the challenging issues that remain.

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Prospective Intraindividual Comparison of Magnetic Resonance Imaging With Gadoxetic Acid and Extracellular Contrast for Diagnosis of Hepatocellular Carcinomas Using the Liver Imaging Reporting and Data System

Min

Kim

et al. 2018

Hepatology

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We intraindividually compared the efficacy of magnetic resonance imaging (MRI) with extracellular contrast agents (ECA-MRI) and MRI with hepatobiliary agents (HBA-MRI) for the diagnosis of hepatocellular carcinoma (HCC) using the Liver Imaging Reporting and Data System (LI-RADS). Between November 2016 and November 2017, we enrolled 91 patients with chronic liver disease who underwent both ECA-MRI and HBA-MRI within a 1-month interval for a first detected hepatic nodule on ultrasound. In total, 117 observations (95 HCCs, 19 benign lesions, and 3 other malignancies; median size, 18 mm) were identified with surgical resection. Two observers assessed two MRIs based on LI-RADS v2017, with consensus by a third observer. We then compared the diagnostic performance of LR-5 according to LI-RADS and modified LI-RADS. ECA-MRI had higher sensitivity (77.9% versus 66.3%) and accuracy (82.1% versus 72.6%) than HBA-MRI in the LR-5 category (P < 0.001). When applying either modified washout on the portal venous phase (PVP)/transitional phase (TP) of HBA-MRI or isointensity with a capsule during the PVP/delayed phase of ECA-MRI (illusional washout), 13 HCCs on HBA-MRI and 11 HCCs on ECA-MRI were correctly classified as HCC, while achieving 100% specificity. One cholangiocarcinoma was accurately classified only with HBA-MRI due to its targetoid appearance in the TP and hepatobiliary phase. Conclusion: ECA-MRI showed better sensitivity and accuracy than HBA-MRI for the diagnosis of HCC with LI-RADS. We achieved better diagnostic performance when applying a modified washout on PVP/TP HBA-MRI and an illusional washout on ECA-MRI than we did with conventional criteria.

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Noninvasive diagnosis of hepatocellular carcinoma on gadoxetic acid-enhanced MRI: can hypointensity on the hepatobiliary phase be used as an alternative to washout?

Abstract: • Gadoxetic acid-enhanced MRI enhancement features can be used to diagnose HCC. • Washout should be determined on the PVP alone for high specificity. • Hypointensity on the TP or HBP increases sensitivity but lowers specificity.

Cited by 127 publications

References 52 publications

Evidence Supporting LI-RADS Major Features for CT- and MR Imaging–based Diagnosis of Hepatocellular Carcinoma: A Systematic Review

Evidence Supporting LI-RADS Major Features for CT- and MR Imaging–based Diagnosis of Hepatocellular Carcinoma: A Systematic Review

Recent Advances in the Imaging Diagnosis of Hepatocellular Carcinoma: Value of Gadoxetic Acid-Enhanced MRI

Prospective Intraindividual Comparison of Magnetic Resonance Imaging With Gadoxetic Acid and Extracellular Contrast for Diagnosis of Hepatocellular Carcinomas Using the Liver Imaging Reporting and Data System

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