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Nahon P, Layese R, Ganne-Carrié N, Moins C, N'Kontchou G, Chaffaut C, Ronot M, Audureau E, Durand-Zaleski I, Natella PA. The clinical and financial burden of nonhepatocellular carcinoma focal lesions detected during the surveillance of patients with cirrhosis. Hepatology 2024; 79:813-828. [PMID: 37774387 DOI: 10.1097/hep.0000000000000615] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/16/2023] [Accepted: 09/01/2023] [Indexed: 10/01/2023]
Abstract
BACKGROUND AND AIMS HCC surveillance is challenged by the detection of hepatic focal lesions (HFLs) of other types. This study aimed to describe the incidence, characteristics, outcomes, and costs of non-HCC HFL detected during surveillance. APPROACH AND RESULTS We retrospectively analyzed nonstandardized workup performed in French patients included in HCC surveillance programs recruited in 57 French tertiary centers (ANRS CirVir and CIRRAL cohorts, HCC 2000 trial). The overall cost of workup was evaluated, with an estimation of an average cost per patient for the entire population and per lesion detected. A total of 3295 patients were followed up for 59.8 months, 391 (11.9%) patients developed HCCs (5-year incidence: 12.1%), and 633 (19.2%) developed non-HCC HFLs (5-year incidence: 21.8%). Characterization of non-HCC HFL required a median additional of 0.7 exams per year. A total of 11.8% of non-HCC HFLs were not confirmed on recall procedures, and 19.6% of non-HCC HFLs remained undetermined. A definite diagnosis of benign liver lesions was made in 65.1%, and malignant tumors were diagnosed in 3.5%. The survival of patients with benign or undetermined non-HCC HFL was similar to that of patients who never developed any HFL (5-year survival 92% vs. 88%, p = 0.07). The average cost of the diagnostic workup was 1087€ for non-HCC HFL and €1572 for HCC. CONCLUSIONS Non-HCC HFLs are frequently detected in patients with cirrhosis, and do not impact prognosis, but trigger substantial costs. This burden must be considered in cost-effectiveness analyses of future personalized surveillance strategies.
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Affiliation(s)
- Pierre Nahon
- AP-HP, Hôpitaux Universitaires Paris Seine Saint-Denis, Liver Department, Bobigny; Université Sorbonne Paris Nord, Bobigny, France
- Inserm, UMR-1138 Functional Genomics of Solid Tumors department, Centre de recherche des Cordeliers, Université de Paris, Paris, France
| | - Richard Layese
- Univ Paris Est Créteil, INSERM, IMRB, Equipe CEpiA (Clinical Epidemiology and Ageing), Unité de Recherche Clinique (URC Mondor), Public health department, Assistance Publique Hôpitaux de Paris (AP-HP), Hôpitaux Universitaires Henri Mondor, Créteil, France
| | - Nathalie Ganne-Carrié
- AP-HP, Hôpitaux Universitaires Paris Seine Saint-Denis, Liver Department, Bobigny; Université Sorbonne Paris Nord, Bobigny, France
- Inserm, UMR-1138 Functional Genomics of Solid Tumors department, Centre de recherche des Cordeliers, Université de Paris, Paris, France
| | - Cécile Moins
- Clinical Research Department, ANRS | Emerging Infectious Diseases, Paris, France
| | - Gisèle N'Kontchou
- AP-HP, Hôpitaux Universitaires Paris Seine Saint-Denis, Liver Department, Bobigny; Université Sorbonne Paris Nord, Bobigny, France
- Inserm, UMR-1138 Functional Genomics of Solid Tumors department, Centre de recherche des Cordeliers, Université de Paris, Paris, France
| | - Cendrine Chaffaut
- SBIM, APHP, Hôpital Saint-Louis, Paris, Inserm, UMR-1153, ECSTRA department, Paris, France
| | - Maxime Ronot
- APHP, Hôpital Beaujon, Radiology department, Hôpital Beaujon, APHP. Nord, Clichy-Sous-Bois, & Université Paris Cité, Paris, France
| | - Etienne Audureau
- Univ Paris Est Créteil, INSERM, IMRB, Equipe CEpiA (Clinical Epidemiology and Ageing), Unité de Recherche Clinique (URC Mondor), Public health department, Assistance Publique Hôpitaux de Paris (AP-HP), Hôpitaux Universitaires Henri Mondor, Créteil, France
| | - Isabelle Durand-Zaleski
- Université de Paris, CRESS, INSERM, INRA, URCECo department, AP-HP, Hôpital de l'Hôtel Dieu, Paris, France
| | - Pierre-André Natella
- Univ Paris Est Créteil, INSERM, IMRB, Equipe CEpiA (Clinical Epidemiology and Ageing), Unité de Recherche Clinique (URC Mondor), Public health department, Assistance Publique Hôpitaux de Paris (AP-HP), Hôpitaux Universitaires Henri Mondor, Créteil, France
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Kamal O, Sy E, Chernyak V, Gupta A, Yaghmai V, Fowler K, Karampinos D, Shanbhogue K, Miller FH, Kambadakone A, Fung A. Optional MRI sequences for LI-RADS: why, what, and how? Abdom Radiol (NY) 2023; 48:519-531. [PMID: 36348024 DOI: 10.1007/s00261-022-03726-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2022] [Revised: 10/21/2022] [Accepted: 10/23/2022] [Indexed: 11/09/2022]
Abstract
Hepatocellular carcinoma (HCC) is the most common primary malignant tumor of the liver worldwide. Noninvasive diagnosis of HCC is possible based on imaging features, without the need for tissue diagnosis. Liver Imaging Reporting and Data System (LI-RADS) CT/MRI diagnostic algorithm allows for standardized radiological interpretation and reporting of imaging studies for patients at high risk for HCC. Diagnostic categories of LR-1 to LR-5 designate each liver observation to reflect the probability of overall malignancy, HCC, or benignity based on imaging features, where LR-5 category has > 95% probability of HCC. Optimal imaging protocol and scanning technique as described by the technical recommendations for LI-RADS are essential for the depiction of features to accurately characterize liver observations. The LI-RADS MRI technical guidelines recommend the minimum required sequences of T1-weighted out-of-phase and in-phase Imaging, T2-weighted Imaging, and multiphase T1-weighted Imaging. Additional sequences, including diffusion-weighted imaging, subtraction imaging, and the hepatobiliary phase when using gadobenate dimeglumine as contrast, improve diagnostic confidence, but are not required by the guidelines. These optional sequences can help differentiate true lesions from pseudolesions, detect additional observations, identify parenchymal observations when other sequences are suboptimal, and improve observations conspicuity. This manuscript reviews the optional sequences, the advantages they offer, and discusses technical optimization of these sequences to obtain the highest image quality and to avoid common artifacts.
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Affiliation(s)
- Omar Kamal
- Oregon Health & Science University, Portland, OR, USA. .,Department of Diagnostic Radiology, Oregon Health & Science University, L340, 3181 SW Sam Jackson Park Road, Portland, OR, 97239, USA.
| | - Ethan Sy
- A.T. Still University School of Osteopathic Medicine in Arizona, Mesa, AZ, USA
| | | | - Ayushi Gupta
- Emory University School of Medicine, Atlanta, Georgia
| | | | | | | | | | - Frank H Miller
- Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | | | - Alice Fung
- Oregon Health & Science University, Portland, OR, USA
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Schoenberger H, Chong N, Fetzer DT, Rich NE, Yokoo T, Khatri G, Olivares J, Parikh ND, Yopp AC, Marrero JA, Singal AG. Dynamic Changes in Ultrasound Quality for Hepatocellular Carcinoma Screening in Patients With Cirrhosis. Clin Gastroenterol Hepatol 2022; 20:1561-1569.e4. [PMID: 34119640 PMCID: PMC8660956 DOI: 10.1016/j.cgh.2021.06.012] [Citation(s) in RCA: 47] [Impact Index Per Article: 23.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/22/2021] [Revised: 05/24/2021] [Accepted: 06/08/2021] [Indexed: 02/06/2023]
Abstract
BACKGROUND & AIMS Identifying patients in whom ultrasound may be inadequate to exclude the presence of hepatocellular carcinoma (HCC) can inform interventions to improve screening effectiveness. We aimed to characterize correlates of suboptimal ultrasound quality and changes in ultrasound quality over time in patients with cirrhosis undergoing HCC screening. METHODS We performed a retrospective cohort study of patients with cirrhosis who underwent ultrasound examination at 2 large health systems between July 2016 and July 2019. Exam adequacy was graded by radiologists using the LI-RADS Visualization Score (A, B, C); we evaluated changes in visualization over time among patients with >1 ultrasound exams. We performed multivariable logistic regression to identify characteristics associated with limited ultrasound visualization (scores B or C). RESULTS Of 2053 cirrhosis patients, 1685 (82.1%) had ultrasounds with score A, 262 (12.8%) had score B, and 106 (5.2%) had score C. Limited visualization was associated with alcohol-related or nonalcoholic fatty liver disease cirrhosis and presence of class II-III obesity. Among 1546 patients with >1 ultrasounds, 1129 (73.0%) had the same visualization score on follow-up (1046 score A, 60 score B, 23 score C). However, 255 (19.6%) of 1301 with score A at baseline had limited visualization when repeated (230 score B, 25 score C), and 130 (53.1%) of 245 patients with baseline limited visualization had good visualization when repeated. CONCLUSIONS Nearly 1 in 5 patients with cirrhosis had moderately-severely limited ultrasound visualization for HCC nodules, particularly those with obesity or alcohol-related or nonalcoholic fatty liver disease cirrhosis. Ultrasound quality can change between exams, including improvement in many patients with limited visualization.
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Affiliation(s)
- Haley Schoenberger
- Department of Internal Medicine, UT Southwestern Medical Center, Dallas, Texas; Parkland Health & Hospital System, Dallas, Texas
| | - Nicolas Chong
- Department of Internal Medicine, UT Southwestern Medical Center, Dallas, Texas; Parkland Health & Hospital System, Dallas, Texas
| | - David T Fetzer
- Department of Radiology, UT Southwestern Medical Center, Dallas, Texas
| | - Nicole E Rich
- Department of Internal Medicine, UT Southwestern Medical Center, Dallas, Texas; Parkland Health & Hospital System, Dallas, Texas
| | - Takeshi Yokoo
- Department of Radiology, UT Southwestern Medical Center, Dallas, Texas
| | - Gaurav Khatri
- Department of Radiology, UT Southwestern Medical Center, Dallas, Texas
| | - Jocelyn Olivares
- Department of Internal Medicine, UT Southwestern Medical Center, Dallas, Texas
| | - Neehar D Parikh
- Department of Internal Medicine, University of Michigan, Ann Arbor, Michigan
| | - Adam C Yopp
- Department of Surgery, UT Southwestern Medical Center, Dallas, Texas
| | - Jorge A Marrero
- Department of Internal Medicine, UT Southwestern Medical Center, Dallas, Texas
| | - Amit G Singal
- Department of Internal Medicine, UT Southwestern Medical Center, Dallas, Texas; Parkland Health & Hospital System, Dallas, Texas.
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Dynamic Liver Magnetic Resonance Imaging During Free Breathing: A Feasibility Study With a Motion Compensated Variable Density Radial Acquisition and a Viewsharing High-Pass Filtering Reconstruction. Invest Radiol 2022; 57:470-477. [PMID: 35136004 DOI: 10.1097/rli.0000000000000859] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE Robust dynamic contrast-enhanced T1-weighted images are crucial for accurate detection and categorization of focal liver lesions in liver/abdominal magnetic resonance imaging (MRI). As optimal dynamic imaging usually requires multiple breath-holds, its inherent susceptibility to motion artifacts frequently results in degraded image quality in incompliant patients. Because free-breathing imaging may overcome this drawback, the intention of this study was to evaluate a dynamic MRI sequence acquired during free breathing using the variable density, elliptical centric golden angle radial stack-of-stars radial sampling scheme, which so far has not been implemented in 4-dimensional applications. MATERIALS AND METHODS In a prospective pilot study, 27 patients received a routine abdominal MRI protocol including the prototype free-breathing sequence (4DFreeBreathing) for dynamic imaging. This enables more convenient and faster reconstruction through variable density, elliptical centric golden angle radial stack-of-stars without the use of additional reconstruction hardware, and even higher motion robustness through soft-gating. A standard breath-hold sequence performed subsequently served as reference standard. Of the continuous dynamic data sets, each dynamic phase was analyzed regarding image quality, motion artifacts and vessel conspicuity using 5-point Likert scales. Furthermore, correct timing of the late arterial phase was compared with the preexaminations. RESULTS 4DFreeBreathing delivered motion-free dynamic images with high temporal resolution in each subject. Overall image quality scores were rated good or excellent for 4DFreeBreathing and the gold standard without significant differences (P = 0.34). There were significantly less motion artifacts in the 4DFreeBreathing sequence (P < 0.0001), whereas vessel conspicuity in each dynamic phase was comparable for both groups (P = 0.45, P > 0.99, P = 0.22, respectively). Correct timing of the late arterial phase could be achieved in 27 of 27 (100%) examinations using 4DFreeBreathing versus 35 of 53 (66%) preexaminations using gold standard (P < 0.001). CONCLUSION The benefit of convenient and fast image reconstruction combined with the superiority in motion robustness and timing compared with standard breath hold sequences renders 4DFreeBreathing an attractive alternative to existing free-breathing techniques in dynamic liver MRI.
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Morshid A, Szklaruk J, Yacoub JH, Elsayes KM. Errors and Misinterpretations in Imaging of Chronic Liver Diseases. Magn Reson Imaging Clin N Am 2021; 29:419-436. [PMID: 34243927 DOI: 10.1016/j.mric.2021.05.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
MRI is an important problem-solving tool for accurate characterization of liver lesions. Chronic liver disease alters the typical imaging characteristics and complicates liver imaging. Awareness of imaging pitfalls and technical artifacts and ways to mitigate them allows for more accurate and timely diagnosis.
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Affiliation(s)
- Ali Morshid
- Department of Diagnostic Radiology, The University of Texas Medical Branch, 301 University Boulevard, Galveston, TX 77555, USA.
| | - Janio Szklaruk
- Department of Diagnostic Radiology, The University of Texas MD Anderson Cancer Center, 1400 Pressler Street, Houston, TX 77030, USA
| | - Joseph H Yacoub
- Department of Radiology, Medstar Georgetown University Hospital, 110 Irving Street Northwest, Washington, DC 20010, USA
| | - Khaled M Elsayes
- Department of Diagnostic Radiology, The University of Texas MD Anderson Cancer Center, 1400 Pressler Street, Houston, TX 77030, USA
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Meng XP, Wang YC, Zhou JY, Yu Q, Lu CQ, Xia C, Tang TY, Xu J, Sun K, Xiao W, Ju S. Comparison of MRI and CT for the Prediction of Microvascular Invasion in Solitary Hepatocellular Carcinoma Based on a Non-Radiomics and Radiomics Method: Which Imaging Modality Is Better? J Magn Reson Imaging 2021; 54:526-536. [PMID: 33622022 DOI: 10.1002/jmri.27575] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2020] [Revised: 02/06/2021] [Accepted: 02/08/2021] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Computed tomography (CT) and magnetic resonance imaging (MRI) are both capable of predicting microvascular invasion (MVI) in hepatocellular carcinoma (HCC). However, which modality is better is unknown. PURPOSE To intraindividually compare CT and MRI for predicting MVI in solitary HCC and investigate the added value of radiomics analyses. STUDY TYPE Retrospective. SUBJECTS Included were 402 consecutive patients with HCC (training set:validation set = 300:102). FIELD STRENGTH/SEQUENCE T2-weighted, diffusion-weighted, and contrast-enhanced T1-weighted imaging MRI at 3.0T and contrast-enhanced CT. ASSESSMENT CT- and MR-based radiomics signatures (RS) were constructed using the least absolute shrinkage and selection operator regression. CT- and MR-based radiologic (R) and radiologic-radiomics (RR) models were developed by univariate and multivariate logistic regression. The performance of the RS/models was compared between two modalities. To investigate the added value of RS, the performance of the R models was compared with the RR models in HCC of all sizes and 2-5 cm in size. STATISTICAL TESTS Model performance was quantified by the area under the receiver operating characteristic curve (AUC) and compared using the Delong test. RESULTS Histopathologic MVI was identified in 161 patients (training set:validation set = 130:31). MRI-based RS/models tended to have a marginally higher AUC than CT-based RS/models (AUCs of CT vs. MRI, P: RS, 0.801 vs. 0.804, 0.96; R model, 0.809 vs. 0.832, 0.09; RR model, 0.835 vs. 0.872, 0.54). The improvement of RR models over R models in all sizes was not significant (P = 0.21 at CT and 0.09 at MRI), whereas the improvement in 2-5 cm was significant at MRI (P < 0.05) but not at CT (P = 0.16). DATA CONCLUSION CT and MRI had a comparable predictive performance for MVI in solitary HCC. The RS of MRI only had significant added value for predicting MVI in HCC of 2-5 cm. LEVEL OF EVIDENCE 3 TECHNICAL EFFICACY: Stage 2.
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Affiliation(s)
- Xiang-Pan Meng
- Department of Radiology, Jiangsu Key Laboratory of Molecular and Functional Imaging, Zhongda Hospital, Medical School of Southeast University, Nanjing, China
| | - Yuan-Cheng Wang
- Department of Radiology, Jiangsu Key Laboratory of Molecular and Functional Imaging, Zhongda Hospital, Medical School of Southeast University, Nanjing, China
| | - Jia-Ying Zhou
- Department of Radiology, Jiangsu Key Laboratory of Molecular and Functional Imaging, Zhongda Hospital, Medical School of Southeast University, Nanjing, China
| | - Qian Yu
- Department of Radiology, Jiangsu Key Laboratory of Molecular and Functional Imaging, Zhongda Hospital, Medical School of Southeast University, Nanjing, China
| | - Chun-Qiang Lu
- Department of Radiology, Jiangsu Key Laboratory of Molecular and Functional Imaging, Zhongda Hospital, Medical School of Southeast University, Nanjing, China
| | - Cong Xia
- Department of Radiology, Jiangsu Key Laboratory of Molecular and Functional Imaging, Zhongda Hospital, Medical School of Southeast University, Nanjing, China
| | - Tian-Yu Tang
- Department of Radiology, Jiangsu Key Laboratory of Molecular and Functional Imaging, Zhongda Hospital, Medical School of Southeast University, Nanjing, China
| | - Jiajia Xu
- Department of Pathology, Zhongda Hospital, Medical School of Southeast University, Nanjing, China
| | - Ke Sun
- Department of Pathology, the First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, China
| | - Wenbo Xiao
- Department of Radiology, the First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, China
| | - Shenghong Ju
- Department of Radiology, Jiangsu Key Laboratory of Molecular and Functional Imaging, Zhongda Hospital, Medical School of Southeast University, Nanjing, China
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Riexinger A, Laun FB, Bickelhaupt S, Seuß H, Uder M, Hensel B, Saake M. On the dependence of the cardiac motion artifact on the breathing cycle in liver diffusion-weighted imaging. PLoS One 2020; 15:e0239743. [PMID: 33002028 PMCID: PMC7529231 DOI: 10.1371/journal.pone.0239743] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2020] [Accepted: 09/11/2020] [Indexed: 12/17/2022] Open
Abstract
Purpose The purpose of this study was to investigate whether the cardiac motion artifact that regularly appears in diffusion-weighted imaging of the left liver lobe might be reduced by acquiring images in inspiration, when the coupling between heart and liver might be minimal. Materials and methods 43 patients with known or suspected focal liver lesions were examined at 1.5 T with breath hold acquisition, once in inspiration and once in expiration. Data were acquired with a diffusion-weighted echo planar imaging sequence and two b-values (b50 = 50 s/mm² and b800 = 800 s/mm²). The severity of the cardiac motion artifact in the left liver lobe was rated by two experienced radiologists for both b-values with a 5 point Likert scale. Additionally, the normalized signal S(b800)/S(b50) in the left liver lobe was computed. The Wilcoxon signed-rank test was used comparing the scores of the two readers obtained in inspiration and expiration, and to compare the normalized signal in inspiration and expiration. Results The normalized signal in inspiration was slightly higher than in expiration (0.349±0.077 vs 0.336±0.058), which would indicate a slight reduction of the cardiac motion artifact, but this difference was not significant (p = 0.24). In the qualitative evaluation, the readers did not observe a significant difference for b50 (reader 1: p = 0.61; reader 2: p = 0.18). For b800, reader 1 observed a significant difference of small effect size favouring expiration (p = 0.03 with a difference of mean Likert scores of 0.27), while reader 2 observed no significant difference (p = 0.62). Conclusion Acquiring the data in inspiration does not lead to a markedly reduced cardiac motion artifact in diffusion-weighted imaging of the left liver lobe and is in this regard not to be preferred over acquiring the data in expiration.
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Affiliation(s)
- Andreas Riexinger
- Institute of Radiology, University Hospital Erlangen, Erlangen, Germany
- * E-mail:
| | | | | | - Hannes Seuß
- Institute of Radiology, University Hospital Erlangen, Erlangen, Germany
| | - Michael Uder
- Institute of Radiology, University Hospital Erlangen, Erlangen, Germany
| | - Bernhard Hensel
- Center for Medical Physics and Engineering, Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU), Erlangen, Germany
| | - Marc Saake
- Institute of Radiology, University Hospital Erlangen, Erlangen, Germany
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Time to peak enhancement of malignant hypervascular hepatic tumors versus that of the aorta evaluating by test bolus sequence of magnetic resonance imaging. Eur J Radiol 2020; 131:109211. [DOI: 10.1016/j.ejrad.2020.109211] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2020] [Revised: 07/12/2020] [Accepted: 08/05/2020] [Indexed: 11/21/2022]
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Examining LI-RADS recommendations: should observation size only be measured on non-arterial phases? Abdom Radiol (NY) 2020; 45:3144-3154. [PMID: 32193590 DOI: 10.1007/s00261-020-02490-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
OBJECTIVE To investigate if size measurements of liver observations is more variable in the arterial phase as suggested by LI-RADS and assess potential higher instability in categorization in this particular phase. Secondarily, to assess inter- and intra-reader agreement for size across phases. MATERIALS AND METHODS Patients with liver cirrhosis who underwent multi-arterial phase MRI between 2017 and 2018 were retrospectively selected. Three radiologists measured liver observations in each phase, independently, in a random order. Mean size between early and late arterial phases (AP), 2, 3 and 10 min delay and the number of observations crossing the LI-RADS size thresholds (10 and 20 mm) per phase were compared using McNemar's test. Reader agreement was evaluated using intraclass correlation coefficient (ICC) and bootstrap-based comparisons. Bonferroni's correction was applied to pairwise comparisons. RESULTS 94 observations (LR-3, LR-4, LR-5, and LR-M) were included. Mean sizes (mm) were late AP: 19.9 (95% CI 17.2, 24.2), 2 min delay: 19.8 (95% CI 17.1, 24.0), 3 min delay: 19.8 (95% CI 17.2, 24.0), 10 min delay: 20.2 (95% CI 17.5, 24.5) (p = 0.10-0.88). There was no difference between phases in number of observations that could have changed category due to variability in size (p = 0.546-1.000). Inter- and intra-reader agreement was excellent (ICC = 0.952-0.981). CONCLUSION Measurements of focal liver observations were consistent across all post-contrast imaging phases and we found no higher instability in LI-RADS category in any particular phase. Inter- and intra-reader agreement for size was excellent for each phase. Based on these findings, size measurement could be allowed on any post-contrast phase, including the arterial phase, if deemed appropriate by the radiologist.
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Kang HJ, Lee JM, Jeon SK, Jang S, Park S, Joo I, Yoon JH, Han JK. Intra-individual comparison of dual portal venous phases for non-invasive diagnosis of hepatocellular carcinoma at gadoxetic acid-enhanced liver MRI. Eur Radiol 2020; 31:824-833. [PMID: 32845387 DOI: 10.1007/s00330-020-07162-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2020] [Revised: 06/18/2020] [Accepted: 08/06/2020] [Indexed: 12/19/2022]
Abstract
OBJECTIVES To compare the diagnostic performances of first and second portal venous phases (PVP1 and PVP2) in revealing washout and capsule appearance for non-invasive HCC diagnoses in gadoxetic acid-enhanced MRI (Gd-EOB-MRI). METHODS This retrospective study included 123 at-risk patients with 160 hepatic observations (HCCs, n = 116; non-HCC malignancies, n = 18; benign, n = 26) showing arterial phase hyper-enhancement (APHE) ≥ 1 cm at Gd-EOB-MRI. The mean time intervals from gadoxetic acid injection to PVP1 and PVP2 acquisitions were 53 ± 2 s and 73 ± 3 s, respectively. After evaluating image findings independently, imaging findings and diagnoses were finalized by a consensus of two radiologists using either PVP1 or PVP2 image sets according to the LI-RADS v2018 or EASL criteria. Sensitivity, specificity, and accuracy were compared. RESULTS Among HCCs, more washout and enhancing capsule were observed in PVP2 (83.6% and 27.6%) than in PVP1 (50.9% and 19.8%) (p < 0.001, both). The PVP2 set presented significantly higher sensitivity (83.6% vs. 53.5%, LI-RADS; 82.8% vs. 50.0%, EASL; p < 0.001, both) and accuracy (0.88 vs. 0.73, LI-RADS; 0.88 vs. 0.72, EASL; p < 0.001, both) than the PVP1 set without significant specificity loss (93.2% vs. 93.2%, by LI-RADS or EASL; p = 0.32, both). None of the non-HCC malignancy was non-invasively diagnosed as HCC in both PVP image sets. CONCLUSION Late acquisition of PVP detected washout and enhancing capsule of HCC more sensitively than early acquisition, enabling accurate diagnoses of HCC, according to LI-RADS or EASL criteria. KEY POINTS • Among HCCs, more washout and enhancing capsules were observed in PVP2 than PVP1, quantitatively and qualitatively. • The portal venous phase acquired at around 70 s after contrast media administration (PVP2) provided significantly higher sensitivity and AUC value than PVP1 by using LI-RADS v2018 or EASL criteria. • More HCCs were categorized as LR-5 in PVP2 than in PVP1 images, and the specificity of PVP2 (93.5%) was comparable with PVP1 (93.5%).
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Affiliation(s)
- Hyo-Jin Kang
- Department of Radiology, Seoul National University Hospital, Seoul, South Korea.,Department of Radiology, Seoul National University College of Medicine, 101 Daehangno, Jongno-gu, Seoul, 03080, South Korea
| | - Jeong Min Lee
- Department of Radiology, Seoul National University Hospital, Seoul, South Korea. .,Department of Radiology, Seoul National University College of Medicine, 101 Daehangno, Jongno-gu, Seoul, 03080, South Korea. .,Institute of Radiation Medicine, Seoul National University Medical Research Center, Seoul, South Korea.
| | - Sun Kyung Jeon
- Department of Radiology, Seoul National University Hospital, Seoul, South Korea.,Department of Radiology, Seoul National University College of Medicine, 101 Daehangno, Jongno-gu, Seoul, 03080, South Korea
| | - Siwon Jang
- Department of Radiology, Seoul National University Boramae Medical Center, Seoul, South Korea
| | - Sungeun Park
- Department of Radiology, Seoul National University Hospital, Seoul, South Korea.,Department of Radiology, Seoul National University College of Medicine, 101 Daehangno, Jongno-gu, Seoul, 03080, South Korea
| | - Ijin Joo
- Department of Radiology, Seoul National University Hospital, Seoul, South Korea.,Department of Radiology, Seoul National University College of Medicine, 101 Daehangno, Jongno-gu, Seoul, 03080, South Korea
| | - Jeong Hee Yoon
- Department of Radiology, Seoul National University Hospital, Seoul, South Korea.,Department of Radiology, Seoul National University College of Medicine, 101 Daehangno, Jongno-gu, Seoul, 03080, South Korea
| | - Joon Koo Han
- Department of Radiology, Seoul National University Hospital, Seoul, South Korea.,Department of Radiology, Seoul National University College of Medicine, 101 Daehangno, Jongno-gu, Seoul, 03080, South Korea.,Institute of Radiation Medicine, Seoul National University Medical Research Center, Seoul, South Korea
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11
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Kim JH, Yoon JH, Joo I, Lee JM. Evaluation of Primary Liver Cancers Using Hepatocyte-Specific Contrast-Enhanced MRI: Pitfalls and Potential Tips. J Magn Reson Imaging 2020; 53:655-675. [PMID: 32700807 DOI: 10.1002/jmri.27213] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2020] [Revised: 04/24/2020] [Accepted: 04/24/2020] [Indexed: 12/11/2022] Open
Abstract
When radiologists interpret hepatic focal lesions seen on dynamic magnetic resonance imaging (MRI) scans, it is important not only to distinguish malignant lesions from benign ones but also to distinguish nonhepatocellular carcinoma (HCC) malignancies from HCCs. In addition, most major guidelines, including those of the American Association for the Study of Liver Disease, European Association for the Study of the Liver, and Korean Liver Cancer Association and National Cancer Center, allow for the noninvasive imaging diagnosis of HCC in at-risk patients. However, ~40% of HCC cases show atypical imaging features mimicking non-HCC malignancies. Furthermore, several benign and malignant lesions, such as flash-filling hemangioma and intrahepatic mass-forming cholangiocarcinoma, frequently look like HCC. In contrast, although multiparametric MRI options, including hepatobiliary phase and diffusion-weighted imaging, provide useful information that could help address these challenges, there remain several unresolved issues with regard to the noninvasive diagnostic criteria characterizing HCC. In this article, we discuss the typical imaging features and challenging situations related to primary liver cancers in MRI, while considering how to make a correct diagnosis. LEVEL OF EVIDENCE: 5 TECHNICAL EFFICACY STAGE: 3.
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Affiliation(s)
- Jae Hyun Kim
- Department of Radiology, Seoul National University Hospital, Seoul, Republic of Korea.,Department of Radiology, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Jeong Hee Yoon
- Department of Radiology, Seoul National University Hospital, Seoul, Republic of Korea.,Department of Radiology, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Ijin Joo
- Department of Radiology, Seoul National University Hospital, Seoul, Republic of Korea.,Department of Radiology, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Jeong Min Lee
- Department of Radiology, Seoul National University Hospital, Seoul, Republic of Korea.,Department of Radiology, Seoul National University College of Medicine, Seoul, Republic of Korea.,Institute of Radiation Medicine, Seoul National University Medical Research Center, Seoul, Republic of Korea
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Rao C, Wang X, Li M, Zhou G, Gu H. Value of T1 mapping on gadoxetic acid-enhanced MRI for microvascular invasion of hepatocellular carcinoma: a retrospective study. BMC Med Imaging 2020; 20:43. [PMID: 32345247 PMCID: PMC7189724 DOI: 10.1186/s12880-020-00433-y] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2019] [Accepted: 03/17/2020] [Indexed: 12/22/2022] Open
Abstract
BACKGROUND To evaluate the utility of non-invasive parameters derived from T1 mapping and diffusion-weighted imaging (DWI) on gadoxetic acid-enhanced MRI for predicting microvascular invasion (MVI) of hepatocellular carcinoma (HCC). METHODS A total of 94 patients with single HCC undergoing partial hepatectomy was analyzed in this retrospective study. Preoperative T1 mapping and DWI on gadoxetic acid-enhanced MRI was performed. The parameters including precontrast, postcontrast and reduction rate of T1 relaxation time and apparent diffusion coefficient (ADC) values were measured for differentiating MVI-positive HCCs (n = 38) from MVI-negative HCCs (n = 56). The receiver operating characteristic curve (ROC) was analyzed to compare the diagnostic performance of the calculated parameters. RESULTS MVI-positive HCCs demonstrated a significantly lower reduction rate of T1 relaxation time than that of MVI-negative HCCs (39.4% vs 49.9, P < 0.001). The areas under receiver operating characteristic curve (AUC) were 0.587, 0.728, 0.824, 0,690 and 0.862 for the precontrast, postcontrast, reduction rate of T1 relaxation time, ADC and the combination of reduction rate and ADC, respectively. The cut-off value of the reduction rate and ADC calculated through maximal Youden index in ROC analyses was 44.9% and 1553.5 s/mm2. To achieve a better diagnostic performance, the criteria of combining the reduction rate lower than 44.9% and the ADC value lower than 1553.5 s/mm2 was proposed with a high specificity of 91.8% and accuracy of 80.9%. CONCLUSIONS The proposed criteria of combining the reduction rate of T1 relaxation time lower than 44.9% and the ADC value lower than 1553.5 s/mm2 on gadoxetic acid-enhanced MRI holds promise for evaluating MVI status of HCC.
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Affiliation(s)
- Chenyi Rao
- Medical College, Nantong University, Nantong, Jiangsu, China
| | - Xinquan Wang
- Medical College, Nantong University, Nantong, Jiangsu, China.,Department of Radiology, Affiliated Hospital of Nantong University, 20 Xisi Rd., Nantong, 226001, Jiangsu, China
| | - Minda Li
- Medical College, Nantong University, Nantong, Jiangsu, China.,Department of Radiology, Affiliated Hospital of Nantong University, 20 Xisi Rd., Nantong, 226001, Jiangsu, China
| | - Guofeng Zhou
- Department of Radiology, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Hongmei Gu
- Medical College, Nantong University, Nantong, Jiangsu, China. .,Department of Radiology, Affiliated Hospital of Nantong University, 20 Xisi Rd., Nantong, 226001, Jiangsu, China.
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