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

Purpose The purpose of this study was to evaluate the diagnostic performance of a “simulated” abbreviated MRI (AMRI) protocol using diffusion-weighted imaging (DWI) and T1-weighted (T1w) imaging obtained at the hepatobiliary phase (HBP) post gadoxetic acid injection alone and in combination, compare...

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Published in:Abdominal imaging 2017-01, Vol.42 (1), p.179-190
Main Authors: Besa, Cecilia, Lewis, Sara, Pandharipande, Pari V., Chhatwal, Jagpreet, Kamath, Amita, Cooper, Nancy, Knight-Greenfield, Ashley, Babb, James S., Boffetta, Paolo, Padron, Norma, Sirlin, Claude B., Taouli, Bachir
Format: Article
Language:English
Subjects:
Adult
Aged
Aged, 80 and over
Carcinoma, Hepatocellular - diagnostic imaging
Contrast Media
Diffusion Magnetic Resonance Imaging
Female
Gadolinium DTPA
Gastroenterology
Hepatology
Humans
Imaging
Liver Neoplasms - diagnostic imaging
Magnetic Resonance Imaging - methods
Male
Medicine
Medicine & Public Health
Middle Aged
Radiology
Retrospective Studies
Sensitivity and Specificity
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Summary:Purpose The purpose of this study was to evaluate the diagnostic performance of a “simulated” abbreviated MRI (AMRI) protocol using diffusion-weighted imaging (DWI) and T1-weighted (T1w) imaging obtained at the hepatobiliary phase (HBP) post gadoxetic acid injection alone and in combination, compared to dynamic contrast-enhanced (CE)-T1w imaging for the detection of hepatocellular carcinoma (HCC). Methods This was an IRB approved HIPAA compliant retrospective single institution study including patients with liver disease who underwent gadoxetic acid-enhanced MRI for HCC diagnosis. Three independent observers assessed 2 sets of images (full CE-set and AMRI including DWI+T1w-HBP). Diagnostic performance of T1w-HBP and DWI alone and in combination was compared to that of CE-set. All imaging sets included unenhanced T1w and T2w sequences. A preliminary analysis was performed to assess cost savings of AMRI protocol compared to a full MRI study. Results 174 patients including 62 with 80 HCCs were assessed. Equivalent per-patient sensitivity and negative predictive value (NPV) were observed for DWI (85.5% and 92.2%, pooled data) and T1w-HBP (89.8% and 94.2%) ( P  = 0.1–0.7), while these were significantly lower for the full AMRI protocol (DWI+T1w-HBP, 80.6% and 80%, P  = 0.02) when compared to CE-set (90.3% and 94.9%). Higher specificity and positive predictive value were observed for CE-set vs. AMRI ( P  = 0.02). The estimated cost reduction of AMRI versus full MRI ranged between 30.7 and 49.0%. Conclusion 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.
ISSN:2366-004X
2366-0058
DOI:10.1007/s00261-016-0841-5