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Hoffmann E, Masthoff M, Kunz WG, Seidensticker M, Bobe S, Gerwing M, Berdel WE, Schliemann C, Faber C, Wildgruber M. Multiparametric MRI for characterization of the tumour microenvironment. Nat Rev Clin Oncol 2024; 21:428-448. [PMID: 38641651 DOI: 10.1038/s41571-024-00891-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/04/2024] [Indexed: 04/21/2024]
Abstract
Our understanding of tumour biology has evolved over the past decades and cancer is now viewed as a complex ecosystem with interactions between various cellular and non-cellular components within the tumour microenvironment (TME) at multiple scales. However, morphological imaging remains the mainstay of tumour staging and assessment of response to therapy, and the characterization of the TME with non-invasive imaging has not yet entered routine clinical practice. By combining multiple MRI sequences, each providing different but complementary information about the TME, multiparametric MRI (mpMRI) enables non-invasive assessment of molecular and cellular features within the TME, including their spatial and temporal heterogeneity. With an increasing number of advanced MRI techniques bridging the gap between preclinical and clinical applications, mpMRI could ultimately guide the selection of treatment approaches, precisely tailored to each individual patient, tumour and therapeutic modality. In this Review, we describe the evolving role of mpMRI in the non-invasive characterization of the TME, outline its applications for cancer detection, staging and assessment of response to therapy, and discuss considerations and challenges for its use in future medical applications, including personalized integrated diagnostics.
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Affiliation(s)
- Emily Hoffmann
- Clinic of Radiology, University of Münster, Münster, Germany
| | - Max Masthoff
- Clinic of Radiology, University of Münster, Münster, Germany
| | - Wolfgang G Kunz
- Department of Radiology, University Hospital, LMU Munich, Munich, Germany
| | - Max Seidensticker
- Department of Radiology, University Hospital, LMU Munich, Munich, Germany
| | - Stefanie Bobe
- Gerhard Domagk Institute of Pathology, University Hospital Münster, Münster, Germany
| | - Mirjam Gerwing
- Clinic of Radiology, University of Münster, Münster, Germany
| | | | | | - Cornelius Faber
- Clinic of Radiology, University of Münster, Münster, Germany
| | - Moritz Wildgruber
- Department of Radiology, University Hospital, LMU Munich, Munich, Germany.
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Qin Z, Zhou Y, Zhang X, Ding J, Zhou H, Wang Y, Zhao L, Chen C, Jing X. The comparison of contrast-enhanced ultrasound and gadoxetate disodium-enhanced MRI LI-RADS for nodules ≤2 cm in patients at high risk for HCC: a prospective study. Front Oncol 2024; 14:1345981. [PMID: 38774417 PMCID: PMC11106436 DOI: 10.3389/fonc.2024.1345981] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2023] [Accepted: 04/12/2024] [Indexed: 05/24/2024] Open
Abstract
Objectives To investigate the consistency of LI-RADS of CEUS and EOB-MRI in the categorization of liver nodules ≤2cm in patients at high risk for HCC. Methods Patients at high risk for HCC with nodules ≤2cm who underwent CEUS and EOB-MRI in our hospital were prospectively enrolled. The CEUS images and EOB-MRI imaging of each liver nodule were observed to evaluate inter-observer consistency and category according to CEUS LI-RADS V2017 and CT/MRI LI-RADS V2017 criteria double blinded. Pathology and/or follow-up were used as reference standard. Results A total of 127 nodules in 119 patients met the inclusion criteria. The inter-observer agreement was good on CEUS and EOB-MRI LI-RADS (kappa = 0.76, 0.76 p < 0.001). The inter-modality agreement was fair (kappa=0.21, p < 0.001). There was no statistical difference in PPV and specificity between CEUS and EOB-MRI LR-5 for HCC, while the difference in AUC was statistically significant. We used new criteria (CEUS LR-5 and EOB-MRI LR-4/5 or CEUS LR-4/5 and EOB-MRI LR-5) to diagnose HCC. The sensitivity, specificity, and AUC of this criteria was 63.4%, 95.6%, and 0.80. Conclusions CEUS and EOB-MRI showed fair inter-modality agreement in LI-RADS categorization of nodules ≤2 cm. The inter-observer agreement of CEUS and EOB-MRI LI-RADS were substantial. CEUS and EOB-MRI LR-5 have equally good positive predictive value and specificity for HCC ≤ 2cm, and combining these two modalities may better diagnose HCC ≤ 2 cm. Clinical Trial Registration https://clinicaltrials.gov/, identifier NCT04212286.
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Affiliation(s)
- Zhengyi Qin
- Department of Ultrasound, Tianjin Third Central Hospital, Tianjin, China
- Tianjin Key Laboratory of Extracorporeal Life Support for Critical Diseases, Tianjin, China
- Artificial Cell Engineering Technology Research Center, Tianjin, China
- Tianjin Institute of Hepatobiliary Disease, Tianjin Third Central Hospital, Tianjin, China
| | - Yan Zhou
- Department of Ultrasound, Tianjin Third Central Hospital, Tianjin, China
- Tianjin Key Laboratory of Extracorporeal Life Support for Critical Diseases, Tianjin, China
- Artificial Cell Engineering Technology Research Center, Tianjin, China
- Tianjin Institute of Hepatobiliary Disease, Tianjin Third Central Hospital, Tianjin, China
- School of Medicine, Nankai University, Tianjin, China
| | - Xiang Zhang
- Department of Radiology, Tianjin Nankai Hospital, Tianjin, China
| | - Jianmin Ding
- Department of Ultrasound, Tianjin Third Central Hospital, Tianjin, China
- Tianjin Key Laboratory of Extracorporeal Life Support for Critical Diseases, Tianjin, China
- Artificial Cell Engineering Technology Research Center, Tianjin, China
- Tianjin Institute of Hepatobiliary Disease, Tianjin Third Central Hospital, Tianjin, China
| | - Hongyu Zhou
- Department of Ultrasound, Tianjin Third Central Hospital, Tianjin, China
- Tianjin Key Laboratory of Extracorporeal Life Support for Critical Diseases, Tianjin, China
- Artificial Cell Engineering Technology Research Center, Tianjin, China
- Tianjin Institute of Hepatobiliary Disease, Tianjin Third Central Hospital, Tianjin, China
| | - Yandong Wang
- Department of Ultrasound, Tianjin Third Central Hospital, Tianjin, China
- Tianjin Key Laboratory of Extracorporeal Life Support for Critical Diseases, Tianjin, China
- Artificial Cell Engineering Technology Research Center, Tianjin, China
- Tianjin Institute of Hepatobiliary Disease, Tianjin Third Central Hospital, Tianjin, China
| | - Lin Zhao
- Department of Ultrasound, Tianjin Third Central Hospital, Tianjin, China
- Tianjin Key Laboratory of Extracorporeal Life Support for Critical Diseases, Tianjin, China
- Artificial Cell Engineering Technology Research Center, Tianjin, China
- Tianjin Institute of Hepatobiliary Disease, Tianjin Third Central Hospital, Tianjin, China
| | - Chen Chen
- Tianjin Key Laboratory of Extracorporeal Life Support for Critical Diseases, Tianjin, China
- Artificial Cell Engineering Technology Research Center, Tianjin, China
- Tianjin Institute of Hepatobiliary Disease, Tianjin Third Central Hospital, Tianjin, China
- Department of Radiology, Tianjin Third Central Hospital, Tianjin, China
| | - Xiang Jing
- Department of Ultrasound, Tianjin Third Central Hospital, Tianjin, China
- Tianjin Key Laboratory of Extracorporeal Life Support for Critical Diseases, Tianjin, China
- Artificial Cell Engineering Technology Research Center, Tianjin, China
- Tianjin Institute of Hepatobiliary Disease, Tianjin Third Central Hospital, Tianjin, China
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Yoon JH, Kim YK, Kim JW, Chang W, Choi JI, Park BJ, Choi JY, Kim SS, Park HS, Lee ES, Yu JS, Park SJ, You MW, Lee CH, Lee JM. Comparison of Four Diagnostic Guidelines for Hepatocellular Carcinoma Using Gadoxetic Acid-enhanced Liver MRI. Radiology 2024; 311:e233114. [PMID: 38563667 DOI: 10.1148/radiol.233114] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/04/2024]
Abstract
Background Noninvasive diagnostic guidelines for hepatocellular carcinoma (HCC) vary across different global geographic areas, especially regarding criteria about gadoxetic acid-enhanced MRI. Purpose To compare the diagnostic performance of four different international HCC diagnosis guidelines and readers' judgment in diagnosing HCC using gadoxetic acid-enhanced MRI in patients at high risk for HCC. Materials and Methods This retrospective study included patients who had not undergone treatment, were at risk for HCC, and who underwent gadoxetic acid-enhanced MRI from January 2015 to June 2018 from 11 tertiary hospitals in South Korea. Four radiologists independently reviewed focal liver lesions (FLLs) according to four guidelines: American Association for the Study of Liver Diseases (AASLD)/Liver Imaging Reporting and Data System (LI-RADS), Korean Liver Cancer Association-National Cancer Center (KLCA-NCC), European Association for the Study of the Liver (EASL), and Asian Pacific Association for the Study of the Liver (APASL). Reader judgment (HCC or not HCC) was also recorded. Malignant FLLs were confirmed at pathology, and histologic and clinical follow-up data were used for benign FLLs. The guidelines' diagnostic performance was compared using generalized estimating equations. Additionally, the diagnostic odds ratio was assessed. Results A total of 2445 FLLs (median size, 27.4 mm) were analyzed in 2237 patients (mean age, 59 years ± 11 [SD]; 1666 male patients); 69.3% (1694 of 2445) were HCCs. KLCA-NCC showed the highest accuracy (80.0%; 95% CI: 78.7, 81.2; P = .001), with high sensitivity in Eastern guidelines (APASL, 89.1% [95% CI: 87.8, 90.3]; KLCA-NCC, 78.2% [95% CI: 76.6, 79.7]) and high specificity in Western guidelines (AASLD/LI-RADS, 89.6% [95% CI: 87.8, 91.2]; EASL, 88.1% [95% CI: 86.2, 89.9]) (P = .001). The diagnostic odds ratios were 20.7 (95% CI: 17.0, 25.3) for AASLD/LI-RADS, 18.9 (95% CI: 15.8, 22.6) for KLCA-NCC, 16.8 (95% CI: 13.8, 20.4) for EASL, and 8.9 (95% CI: 7.4, 10.7) for APASL. The readers' judgment demonstrated higher accuracy than that of the guidelines (accuracy, 86.0%; 95% CI: 84.9, 86.9; P = .001). Conclusion Among four different international HCC diagnosis guidelines, Eastern guidelines demonstrated higher sensitivity, whereas Western guidelines displayed higher specificity. KLCA-NCC achieved the highest accuracy, and AASLD/LI-RADS exhibited the highest diagnostic odds ratio. © RSNA, 2024 Supplemental material is available for this article.
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Affiliation(s)
- Jeong Hee Yoon
- From the Department of Radiology, Seoul National University Hospital & College of Medicine, Seoul 03080, Republic of Korea (J.H.Y., J.M.L.); Department of Radiology and Center for Imaging Science, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea (Y.K.K.); Department of Radiology, Korea University Guro Hospital & College of Medicine, Seoul, Republic of Korea (J.W.K., C.H.L.); Department of Radiology, Seoul National University Bundang Hospital, Seongnam, Republic of Korea (W.C.); Department of Radiology, Seoul Saint Mary's Hospital & College of Medicine, Catholic University of Korea, Seoul, Republic of Korea (J.I.C.); Department of Radiology, Korea University Anam Hospital, Seoul, Republic of Korea (B.J.P.); Department of Radiology and Research Institute of Radiological Science, Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea (J.Y.C., S.K.); Department of Radiology, Konkuk University School of Medicine, Seoul, Republic of Korea (H.S.P.); Department of Radiology, Chung-Ang University Hospital, Seoul, Republic of Korea (E.S.L.); Department of Radiology, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea (J.S.Y.); Department of Radiology, Kyung Hee University College of Medicine and Kyung Hee University Hospital, Seoul, Republic of Korea (S.J.P., M.W.Y.); and Institute of Radiation Medicine, Seoul National University Medical Research Center, Seoul, Republic of Korea (J.M.L.)
| | - Young Kon Kim
- From the Department of Radiology, Seoul National University Hospital & College of Medicine, Seoul 03080, Republic of Korea (J.H.Y., J.M.L.); Department of Radiology and Center for Imaging Science, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea (Y.K.K.); Department of Radiology, Korea University Guro Hospital & College of Medicine, Seoul, Republic of Korea (J.W.K., C.H.L.); Department of Radiology, Seoul National University Bundang Hospital, Seongnam, Republic of Korea (W.C.); Department of Radiology, Seoul Saint Mary's Hospital & College of Medicine, Catholic University of Korea, Seoul, Republic of Korea (J.I.C.); Department of Radiology, Korea University Anam Hospital, Seoul, Republic of Korea (B.J.P.); Department of Radiology and Research Institute of Radiological Science, Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea (J.Y.C., S.K.); Department of Radiology, Konkuk University School of Medicine, Seoul, Republic of Korea (H.S.P.); Department of Radiology, Chung-Ang University Hospital, Seoul, Republic of Korea (E.S.L.); Department of Radiology, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea (J.S.Y.); Department of Radiology, Kyung Hee University College of Medicine and Kyung Hee University Hospital, Seoul, Republic of Korea (S.J.P., M.W.Y.); and Institute of Radiation Medicine, Seoul National University Medical Research Center, Seoul, Republic of Korea (J.M.L.)
| | - Jeong Woo Kim
- From the Department of Radiology, Seoul National University Hospital & College of Medicine, Seoul 03080, Republic of Korea (J.H.Y., J.M.L.); Department of Radiology and Center for Imaging Science, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea (Y.K.K.); Department of Radiology, Korea University Guro Hospital & College of Medicine, Seoul, Republic of Korea (J.W.K., C.H.L.); Department of Radiology, Seoul National University Bundang Hospital, Seongnam, Republic of Korea (W.C.); Department of Radiology, Seoul Saint Mary's Hospital & College of Medicine, Catholic University of Korea, Seoul, Republic of Korea (J.I.C.); Department of Radiology, Korea University Anam Hospital, Seoul, Republic of Korea (B.J.P.); Department of Radiology and Research Institute of Radiological Science, Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea (J.Y.C., S.K.); Department of Radiology, Konkuk University School of Medicine, Seoul, Republic of Korea (H.S.P.); Department of Radiology, Chung-Ang University Hospital, Seoul, Republic of Korea (E.S.L.); Department of Radiology, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea (J.S.Y.); Department of Radiology, Kyung Hee University College of Medicine and Kyung Hee University Hospital, Seoul, Republic of Korea (S.J.P., M.W.Y.); and Institute of Radiation Medicine, Seoul National University Medical Research Center, Seoul, Republic of Korea (J.M.L.)
| | - Won Chang
- From the Department of Radiology, Seoul National University Hospital & College of Medicine, Seoul 03080, Republic of Korea (J.H.Y., J.M.L.); Department of Radiology and Center for Imaging Science, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea (Y.K.K.); Department of Radiology, Korea University Guro Hospital & College of Medicine, Seoul, Republic of Korea (J.W.K., C.H.L.); Department of Radiology, Seoul National University Bundang Hospital, Seongnam, Republic of Korea (W.C.); Department of Radiology, Seoul Saint Mary's Hospital & College of Medicine, Catholic University of Korea, Seoul, Republic of Korea (J.I.C.); Department of Radiology, Korea University Anam Hospital, Seoul, Republic of Korea (B.J.P.); Department of Radiology and Research Institute of Radiological Science, Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea (J.Y.C., S.K.); Department of Radiology, Konkuk University School of Medicine, Seoul, Republic of Korea (H.S.P.); Department of Radiology, Chung-Ang University Hospital, Seoul, Republic of Korea (E.S.L.); Department of Radiology, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea (J.S.Y.); Department of Radiology, Kyung Hee University College of Medicine and Kyung Hee University Hospital, Seoul, Republic of Korea (S.J.P., M.W.Y.); and Institute of Radiation Medicine, Seoul National University Medical Research Center, Seoul, Republic of Korea (J.M.L.)
| | - Joon-Il Choi
- From the Department of Radiology, Seoul National University Hospital & College of Medicine, Seoul 03080, Republic of Korea (J.H.Y., J.M.L.); Department of Radiology and Center for Imaging Science, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea (Y.K.K.); Department of Radiology, Korea University Guro Hospital & College of Medicine, Seoul, Republic of Korea (J.W.K., C.H.L.); Department of Radiology, Seoul National University Bundang Hospital, Seongnam, Republic of Korea (W.C.); Department of Radiology, Seoul Saint Mary's Hospital & College of Medicine, Catholic University of Korea, Seoul, Republic of Korea (J.I.C.); Department of Radiology, Korea University Anam Hospital, Seoul, Republic of Korea (B.J.P.); Department of Radiology and Research Institute of Radiological Science, Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea (J.Y.C., S.K.); Department of Radiology, Konkuk University School of Medicine, Seoul, Republic of Korea (H.S.P.); Department of Radiology, Chung-Ang University Hospital, Seoul, Republic of Korea (E.S.L.); Department of Radiology, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea (J.S.Y.); Department of Radiology, Kyung Hee University College of Medicine and Kyung Hee University Hospital, Seoul, Republic of Korea (S.J.P., M.W.Y.); and Institute of Radiation Medicine, Seoul National University Medical Research Center, Seoul, Republic of Korea (J.M.L.)
| | - Beom Jin Park
- From the Department of Radiology, Seoul National University Hospital & College of Medicine, Seoul 03080, Republic of Korea (J.H.Y., J.M.L.); Department of Radiology and Center for Imaging Science, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea (Y.K.K.); Department of Radiology, Korea University Guro Hospital & College of Medicine, Seoul, Republic of Korea (J.W.K., C.H.L.); Department of Radiology, Seoul National University Bundang Hospital, Seongnam, Republic of Korea (W.C.); Department of Radiology, Seoul Saint Mary's Hospital & College of Medicine, Catholic University of Korea, Seoul, Republic of Korea (J.I.C.); Department of Radiology, Korea University Anam Hospital, Seoul, Republic of Korea (B.J.P.); Department of Radiology and Research Institute of Radiological Science, Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea (J.Y.C., S.K.); Department of Radiology, Konkuk University School of Medicine, Seoul, Republic of Korea (H.S.P.); Department of Radiology, Chung-Ang University Hospital, Seoul, Republic of Korea (E.S.L.); Department of Radiology, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea (J.S.Y.); Department of Radiology, Kyung Hee University College of Medicine and Kyung Hee University Hospital, Seoul, Republic of Korea (S.J.P., M.W.Y.); and Institute of Radiation Medicine, Seoul National University Medical Research Center, Seoul, Republic of Korea (J.M.L.)
| | - Jin-Young Choi
- From the Department of Radiology, Seoul National University Hospital & College of Medicine, Seoul 03080, Republic of Korea (J.H.Y., J.M.L.); Department of Radiology and Center for Imaging Science, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea (Y.K.K.); Department of Radiology, Korea University Guro Hospital & College of Medicine, Seoul, Republic of Korea (J.W.K., C.H.L.); Department of Radiology, Seoul National University Bundang Hospital, Seongnam, Republic of Korea (W.C.); Department of Radiology, Seoul Saint Mary's Hospital & College of Medicine, Catholic University of Korea, Seoul, Republic of Korea (J.I.C.); Department of Radiology, Korea University Anam Hospital, Seoul, Republic of Korea (B.J.P.); Department of Radiology and Research Institute of Radiological Science, Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea (J.Y.C., S.K.); Department of Radiology, Konkuk University School of Medicine, Seoul, Republic of Korea (H.S.P.); Department of Radiology, Chung-Ang University Hospital, Seoul, Republic of Korea (E.S.L.); Department of Radiology, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea (J.S.Y.); Department of Radiology, Kyung Hee University College of Medicine and Kyung Hee University Hospital, Seoul, Republic of Korea (S.J.P., M.W.Y.); and Institute of Radiation Medicine, Seoul National University Medical Research Center, Seoul, Republic of Korea (J.M.L.)
| | - Seung-Seob Kim
- From the Department of Radiology, Seoul National University Hospital & College of Medicine, Seoul 03080, Republic of Korea (J.H.Y., J.M.L.); Department of Radiology and Center for Imaging Science, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea (Y.K.K.); Department of Radiology, Korea University Guro Hospital & College of Medicine, Seoul, Republic of Korea (J.W.K., C.H.L.); Department of Radiology, Seoul National University Bundang Hospital, Seongnam, Republic of Korea (W.C.); Department of Radiology, Seoul Saint Mary's Hospital & College of Medicine, Catholic University of Korea, Seoul, Republic of Korea (J.I.C.); Department of Radiology, Korea University Anam Hospital, Seoul, Republic of Korea (B.J.P.); Department of Radiology and Research Institute of Radiological Science, Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea (J.Y.C., S.K.); Department of Radiology, Konkuk University School of Medicine, Seoul, Republic of Korea (H.S.P.); Department of Radiology, Chung-Ang University Hospital, Seoul, Republic of Korea (E.S.L.); Department of Radiology, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea (J.S.Y.); Department of Radiology, Kyung Hee University College of Medicine and Kyung Hee University Hospital, Seoul, Republic of Korea (S.J.P., M.W.Y.); and Institute of Radiation Medicine, Seoul National University Medical Research Center, Seoul, Republic of Korea (J.M.L.)
| | - Hee Sun Park
- From the Department of Radiology, Seoul National University Hospital & College of Medicine, Seoul 03080, Republic of Korea (J.H.Y., J.M.L.); Department of Radiology and Center for Imaging Science, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea (Y.K.K.); Department of Radiology, Korea University Guro Hospital & College of Medicine, Seoul, Republic of Korea (J.W.K., C.H.L.); Department of Radiology, Seoul National University Bundang Hospital, Seongnam, Republic of Korea (W.C.); Department of Radiology, Seoul Saint Mary's Hospital & College of Medicine, Catholic University of Korea, Seoul, Republic of Korea (J.I.C.); Department of Radiology, Korea University Anam Hospital, Seoul, Republic of Korea (B.J.P.); Department of Radiology and Research Institute of Radiological Science, Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea (J.Y.C., S.K.); Department of Radiology, Konkuk University School of Medicine, Seoul, Republic of Korea (H.S.P.); Department of Radiology, Chung-Ang University Hospital, Seoul, Republic of Korea (E.S.L.); Department of Radiology, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea (J.S.Y.); Department of Radiology, Kyung Hee University College of Medicine and Kyung Hee University Hospital, Seoul, Republic of Korea (S.J.P., M.W.Y.); and Institute of Radiation Medicine, Seoul National University Medical Research Center, Seoul, Republic of Korea (J.M.L.)
| | - Eun Sun Lee
- From the Department of Radiology, Seoul National University Hospital & College of Medicine, Seoul 03080, Republic of Korea (J.H.Y., J.M.L.); Department of Radiology and Center for Imaging Science, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea (Y.K.K.); Department of Radiology, Korea University Guro Hospital & College of Medicine, Seoul, Republic of Korea (J.W.K., C.H.L.); Department of Radiology, Seoul National University Bundang Hospital, Seongnam, Republic of Korea (W.C.); Department of Radiology, Seoul Saint Mary's Hospital & College of Medicine, Catholic University of Korea, Seoul, Republic of Korea (J.I.C.); Department of Radiology, Korea University Anam Hospital, Seoul, Republic of Korea (B.J.P.); Department of Radiology and Research Institute of Radiological Science, Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea (J.Y.C., S.K.); Department of Radiology, Konkuk University School of Medicine, Seoul, Republic of Korea (H.S.P.); Department of Radiology, Chung-Ang University Hospital, Seoul, Republic of Korea (E.S.L.); Department of Radiology, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea (J.S.Y.); Department of Radiology, Kyung Hee University College of Medicine and Kyung Hee University Hospital, Seoul, Republic of Korea (S.J.P., M.W.Y.); and Institute of Radiation Medicine, Seoul National University Medical Research Center, Seoul, Republic of Korea (J.M.L.)
| | - Jeong-Sik Yu
- From the Department of Radiology, Seoul National University Hospital & College of Medicine, Seoul 03080, Republic of Korea (J.H.Y., J.M.L.); Department of Radiology and Center for Imaging Science, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea (Y.K.K.); Department of Radiology, Korea University Guro Hospital & College of Medicine, Seoul, Republic of Korea (J.W.K., C.H.L.); Department of Radiology, Seoul National University Bundang Hospital, Seongnam, Republic of Korea (W.C.); Department of Radiology, Seoul Saint Mary's Hospital & College of Medicine, Catholic University of Korea, Seoul, Republic of Korea (J.I.C.); Department of Radiology, Korea University Anam Hospital, Seoul, Republic of Korea (B.J.P.); Department of Radiology and Research Institute of Radiological Science, Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea (J.Y.C., S.K.); Department of Radiology, Konkuk University School of Medicine, Seoul, Republic of Korea (H.S.P.); Department of Radiology, Chung-Ang University Hospital, Seoul, Republic of Korea (E.S.L.); Department of Radiology, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea (J.S.Y.); Department of Radiology, Kyung Hee University College of Medicine and Kyung Hee University Hospital, Seoul, Republic of Korea (S.J.P., M.W.Y.); and Institute of Radiation Medicine, Seoul National University Medical Research Center, Seoul, Republic of Korea (J.M.L.)
| | - Seong Jin Park
- From the Department of Radiology, Seoul National University Hospital & College of Medicine, Seoul 03080, Republic of Korea (J.H.Y., J.M.L.); Department of Radiology and Center for Imaging Science, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea (Y.K.K.); Department of Radiology, Korea University Guro Hospital & College of Medicine, Seoul, Republic of Korea (J.W.K., C.H.L.); Department of Radiology, Seoul National University Bundang Hospital, Seongnam, Republic of Korea (W.C.); Department of Radiology, Seoul Saint Mary's Hospital & College of Medicine, Catholic University of Korea, Seoul, Republic of Korea (J.I.C.); Department of Radiology, Korea University Anam Hospital, Seoul, Republic of Korea (B.J.P.); Department of Radiology and Research Institute of Radiological Science, Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea (J.Y.C., S.K.); Department of Radiology, Konkuk University School of Medicine, Seoul, Republic of Korea (H.S.P.); Department of Radiology, Chung-Ang University Hospital, Seoul, Republic of Korea (E.S.L.); Department of Radiology, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea (J.S.Y.); Department of Radiology, Kyung Hee University College of Medicine and Kyung Hee University Hospital, Seoul, Republic of Korea (S.J.P., M.W.Y.); and Institute of Radiation Medicine, Seoul National University Medical Research Center, Seoul, Republic of Korea (J.M.L.)
| | - Myung-Won You
- From the Department of Radiology, Seoul National University Hospital & College of Medicine, Seoul 03080, Republic of Korea (J.H.Y., J.M.L.); Department of Radiology and Center for Imaging Science, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea (Y.K.K.); Department of Radiology, Korea University Guro Hospital & College of Medicine, Seoul, Republic of Korea (J.W.K., C.H.L.); Department of Radiology, Seoul National University Bundang Hospital, Seongnam, Republic of Korea (W.C.); Department of Radiology, Seoul Saint Mary's Hospital & College of Medicine, Catholic University of Korea, Seoul, Republic of Korea (J.I.C.); Department of Radiology, Korea University Anam Hospital, Seoul, Republic of Korea (B.J.P.); Department of Radiology and Research Institute of Radiological Science, Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea (J.Y.C., S.K.); Department of Radiology, Konkuk University School of Medicine, Seoul, Republic of Korea (H.S.P.); Department of Radiology, Chung-Ang University Hospital, Seoul, Republic of Korea (E.S.L.); Department of Radiology, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea (J.S.Y.); Department of Radiology, Kyung Hee University College of Medicine and Kyung Hee University Hospital, Seoul, Republic of Korea (S.J.P., M.W.Y.); and Institute of Radiation Medicine, Seoul National University Medical Research Center, Seoul, Republic of Korea (J.M.L.)
| | - Chang Hee Lee
- From the Department of Radiology, Seoul National University Hospital & College of Medicine, Seoul 03080, Republic of Korea (J.H.Y., J.M.L.); Department of Radiology and Center for Imaging Science, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea (Y.K.K.); Department of Radiology, Korea University Guro Hospital & College of Medicine, Seoul, Republic of Korea (J.W.K., C.H.L.); Department of Radiology, Seoul National University Bundang Hospital, Seongnam, Republic of Korea (W.C.); Department of Radiology, Seoul Saint Mary's Hospital & College of Medicine, Catholic University of Korea, Seoul, Republic of Korea (J.I.C.); Department of Radiology, Korea University Anam Hospital, Seoul, Republic of Korea (B.J.P.); Department of Radiology and Research Institute of Radiological Science, Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea (J.Y.C., S.K.); Department of Radiology, Konkuk University School of Medicine, Seoul, Republic of Korea (H.S.P.); Department of Radiology, Chung-Ang University Hospital, Seoul, Republic of Korea (E.S.L.); Department of Radiology, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea (J.S.Y.); Department of Radiology, Kyung Hee University College of Medicine and Kyung Hee University Hospital, Seoul, Republic of Korea (S.J.P., M.W.Y.); and Institute of Radiation Medicine, Seoul National University Medical Research Center, Seoul, Republic of Korea (J.M.L.)
| | - Jeong Min Lee
- From the Department of Radiology, Seoul National University Hospital & College of Medicine, Seoul 03080, Republic of Korea (J.H.Y., J.M.L.); Department of Radiology and Center for Imaging Science, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea (Y.K.K.); Department of Radiology, Korea University Guro Hospital & College of Medicine, Seoul, Republic of Korea (J.W.K., C.H.L.); Department of Radiology, Seoul National University Bundang Hospital, Seongnam, Republic of Korea (W.C.); Department of Radiology, Seoul Saint Mary's Hospital & College of Medicine, Catholic University of Korea, Seoul, Republic of Korea (J.I.C.); Department of Radiology, Korea University Anam Hospital, Seoul, Republic of Korea (B.J.P.); Department of Radiology and Research Institute of Radiological Science, Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea (J.Y.C., S.K.); Department of Radiology, Konkuk University School of Medicine, Seoul, Republic of Korea (H.S.P.); Department of Radiology, Chung-Ang University Hospital, Seoul, Republic of Korea (E.S.L.); Department of Radiology, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea (J.S.Y.); Department of Radiology, Kyung Hee University College of Medicine and Kyung Hee University Hospital, Seoul, Republic of Korea (S.J.P., M.W.Y.); and Institute of Radiation Medicine, Seoul National University Medical Research Center, Seoul, Republic of Korea (J.M.L.)
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Lee S, Kim YY, Shin J, Roh YH, Choi JY, Chernyak V, Sirlin CB. Liver Imaging Reporting and Data System version 2018 category 5 for diagnosing hepatocellular carcinoma: an updated meta-analysis. Eur Radiol 2024; 34:1502-1514. [PMID: 37656177 DOI: 10.1007/s00330-023-10134-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2022] [Revised: 05/24/2023] [Accepted: 07/07/2023] [Indexed: 09/02/2023]
Abstract
OBJECTIVE We performed an updated meta-analysis to determine the diagnostic performance of Liver Imaging Reporting and Data System (LI-RADS, LR) 5 category for hepatocellular carcinoma (HCC) using LI-RADS version 2018 (v2018), and to evaluate differences by imaging modalities and type of MRI contrast material. METHODS The MEDLINE and Embase databases were searched for studies reporting the performance of LR-5 using v2018 for diagnosing HCC. A bivariate random-effects model was used to calculate the pooled per-observation sensitivity and specificity. Subgroup analysis was performed based on imaging modalities and type of MRI contrast material. RESULTS Forty-eight studies qualified for the meta-analysis, comprising 9031 patients, 10,547 observations, and 7216 HCCs. The pooled per-observation sensitivity and specificity of LR-5 for diagnosing HCC were 66% (95% CI, 61-70%) and 91% (95% CI, 89-93%), respectively. In the subgroup analysis, MRI with extracellular agent (ECA-MRI) showed significantly higher pooled sensitivity (77% [95% CI, 70-82%]) than CT (66% [95% CI, 58-73%]; p = 0.023) or MRI with gadoxetate (Gx-MRI) (65% [95% CI, 60-70%]; p = 0.001), but there was no significant difference between ECA-MRI and MRI with gadobenate (gadobenate-MRI) (73% [95% CI, 61-82%]; p = 0.495). Pooled specificities were 88% (95% CI, 80-93%) for CT, 92% (95% CI, 86-95%) for ECA-MRI, 93% (95% CI, 91-95%) for Gx-MRI, and 91% (95% CI, 84-95%) for gadobenate-MRI without significant differences (p = 0.084-0.803). CONCLUSIONS LI-RADS v2018 LR-5 provides high specificity for HCC diagnosis regardless of modality or contrast material, while ECA-MRI showed higher sensitivity than CT or Gx-MRI. CLINICAL RELEVANCE STATEMENT Refinement of the criteria for improving sensitivity while maintaining high specificity of LR-5 for HCC diagnosis may be an essential future direction. KEY POINTS • The pooled per-observation sensitivity and specificity of LR-5 for diagnosing HCC using LI-RADSv2018 were 66% and 91%, respectively. • ECA-MRI showed higher sensitivity than CT (77% vs 66%, p = 0.023) or Gx-MRI (77% vs 65%, p = 0.001). • LI-RADS v2018 LR-5 provides high specificity (88-93%) for HCC diagnosis regardless of modality or contrast material type.
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Affiliation(s)
- Sunyoung Lee
- Department of Radiology and Research Institute of Radiological Science, Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea.
| | - Yeun-Yoon Kim
- Department of Radiology and Research Institute of Radiological Science, Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Jaeseung Shin
- Department of Radiology and Center for Imaging Science, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Yun Ho Roh
- Biostatistics Collaboration Unit, Department of Biomedical Systems Informatics, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Jin-Young Choi
- Department of Radiology and Research Institute of Radiological Science, Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Victoria Chernyak
- Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Claude B Sirlin
- Liver Imaging Group, Department of Radiology, University of California San Diego, San Diego, CA, USA
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Choi JY, Park R, Choi SH, Jang HJ, Choi SJ, Heo S. Does threshold growth benefit imaging criteria when used as a major diagnostic imaging feature for hepatocellular carcinoma? Eur J Radiol 2023; 169:111188. [PMID: 37949022 DOI: 10.1016/j.ejrad.2023.111188] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2023] [Revised: 10/22/2023] [Accepted: 11/02/2023] [Indexed: 11/12/2023]
Abstract
PURPOSE To evaluate the added value of threshold growth (TG) for imaging criteria for diagnosing hepatocellular carcinoma (HCC) on gadoxetic acid-enhanced MRI. METHODS Patients who underwent preoperative gadoxetic acid-enhanced MRI because of absence of 'definite HCC' (Liver Imaging Reporting and Data System category 5) on prior CT or MRI between January 2016 and December 2020 were retrospectively analyzed. The sensitivity and specificity for 'definite HCC' according to the criteria of the European Association for the Study of the Liver [EASL], Asian Pacific Association for the Study of the Liver [APASL], and Korean Liver Cancer Association-National Cancer Center [KLCA-NCC] were separately calculated with and without TG as a major imaging feature. The results were compared using generalized estimating equations. RESULTS Of 202 nodules in 154 patients, 19 % showed TG. When TG was used as a major imaging feature, the sensitivity of EASL were significantly higher than when it was not used (59.2 % vs. 51.4 %, p = 0.001), whereas the sensitivities of APASL and KLCA-NCC did not significantly differ. No significant difference was found in the specificities of the three imaging criteria when TG was used or not (p ≥ 0.16). Of 11 HCCs additionally detected when TG was added to EASL criteria, 9 showed transitional-phase or hepatobiliary-phase hypointensity without portal venous-phase washout. CONCLUSION TG had added value for improving the sensitivity of EASL criteria for gadoxetic acid-enhanced MRI without extending washout to transitional-phase or hepatobiliary-phase images.
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Affiliation(s)
- Ji Young Choi
- Department of Radiology and Research Institute of Radiology, University of Ulsan College of Medicine, Asan Medical Center, Republic of Korea; Department of Radiology, Kangbuk Samsung Hospital, Sungkyunkwan University College of Medicine, Republic of Korea
| | - Rohee Park
- Department of Radiology and Research Institute of Radiology, University of Ulsan College of Medicine, Asan Medical Center, Republic of Korea
| | - Sang Hyun Choi
- Department of Radiology and Research Institute of Radiology, University of Ulsan College of Medicine, Asan Medical Center, Republic of Korea.
| | - Hyeon Ji Jang
- Department of Radiology and Research Institute of Radiology, University of Ulsan College of Medicine, Asan Medical Center, Republic of Korea
| | - Se Jin Choi
- Department of Radiology and Research Institute of Radiology, University of Ulsan College of Medicine, Asan Medical Center, Republic of Korea
| | - Subin Heo
- Department of Radiology and Research Institute of Radiology, University of Ulsan College of Medicine, Asan Medical Center, Republic of Korea
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Shin J, Lee S, Yoon JK, Roh YH. Diagnostic Performance of the 2018 EASL vs. LI-RADS for Hepatocellular Carcinoma Using CT and MRI: A Systematic Review and Meta-Analysis of Comparative Studies. J Magn Reson Imaging 2023; 58:1942-1950. [PMID: 37010244 DOI: 10.1002/jmri.28716] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2023] [Revised: 03/21/2023] [Accepted: 03/21/2023] [Indexed: 04/04/2023] Open
Abstract
BACKGROUND Hepatocellular carcinoma (HCC) can be diagnosed without pathologic confirmation in high-risk patients. Therefore, it is necessary to compare current imaging criteria for noninvasive-diagnosis of HCC. PURPOSE To systematically compare performance of 2018 European Association for the Study of the Liver (EASL) criteria and Liver Imaging Reporting and Data System (LI-RADS) for noninvasive-diagnosis of HCC. STUDY TYPE Systematic review and meta-analysis. SUBJECTS Eight studies with 2232 observations, including 1617 HCCs. FIELD STRENGTH/SEQUENCE 1.5 T, 3.0 T/T2-weighted, unenhanced T1-weighted in-/opposed-phases, multiphase T1-weighted imaging. ASSESSMENT Following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, two reviewers independently reviewed and extracted data, including patient characteristics, index test, reference standard and outcomes, from studies intraindividually comparing the sensitivities and specificities of 2018 EASL-criteria and LR-5 of LI-RADS for HCC. Risk of bias and concerns regarding applicability were evaluated using QUADAS-2 tool. Subgroup analysis was performed based on observation size (≥20 mm, 10-19 mm). STATISTICAL TESTS Bivariate random-effects model to calculate pooled per-observation sensitivity and specificity of both imaging criteria, and pooled estimates of intraindividual paired data were compared considering the correlation. Forest and linked-receiver-operating-characteristic plots were drawn, and study heterogeneity was assessed using Q-test and Higgins-index. Publication bias was evaluated by Egger's test. A P-value <0.05 was considered statistically significant, except for heterogeneity (P < 0.10). RESULTS The sensitivity for HCC did not differ significantly between the imaging-based diagnosis using EASL-criteria (61%; 95% CI, 50%-73%) and LR-5 (64%; 95% CI, 53%-76%; P = 0.165). The specificities were also not significantly different between EASL-criteria (92%; 95% CI, 89%-94%) and LR-5 (94%; 95% CI, 91%-96%; P = 0.257). In subgroup analysis, no statistically significant differences were identified in the pooled performances between the two criteria for observations ≥20 mm (sensitivity P = 0.065; specificity P = 0.343) or 10-19 mm (sensitivity P > 0.999; specificity P = 0.851). There was no publication bias for EASL (P = 0.396) and LI-RADS (P = 0.526). DATA CONCLUSION In the present meta-analysis of paired comparisons, the pooled sensitivities and specificities were not significantly different between 2018 EASL-criteria and LR-5 of LI-RADS for noninvasive-diagnosis of HCC. EVIDENCE LEVEL 3. TECHNICAL EFFICACY Stage 2.
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Affiliation(s)
- Jaeseung Shin
- Department of Radiology and Research Institute of Radiological Science, Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea
- Department of Radiology and Center for Imaging Science, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Sunyoung Lee
- Department of Radiology and Research Institute of Radiological Science, Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Ja Kyung Yoon
- Department of Radiology and Research Institute of Radiological Science, Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Yun Ho Roh
- Biostatistics Collaboration Unit, Department of Biomedical Systems Informatics, Yonsei University College of Medicine, Seoul, Republic of Korea
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Dioguardi Burgio M, Garzelli L, Cannella R, Ronot M, Vilgrain V. Hepatocellular Carcinoma: Optimal Radiological Evaluation before Liver Transplantation. Life (Basel) 2023; 13:2267. [PMID: 38137868 PMCID: PMC10744421 DOI: 10.3390/life13122267] [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: 09/04/2023] [Revised: 10/27/2023] [Accepted: 11/24/2023] [Indexed: 12/24/2023] Open
Abstract
Liver transplantation (LT) is the recommended curative-intent treatment for patients with early or intermediate-stage hepatocellular carcinoma (HCC) who are ineligible for resection. Imaging plays a central role in staging and for selecting the best LT candidates. This review will discuss recent developments in pre-LT imaging assessment, in particular LT eligibility criteria on imaging, the technical requirements and the diagnostic performance of imaging for the pre-LT diagnosis of HCC including the recent Liver Imaging Reporting and Data System (LI-RADS) criteria, the evaluation of the response to locoregional therapy, as well as the non-invasive prediction of HCC aggressiveness and its impact on the outcome of LT. We will also briefly discuss the role of nuclear medicine in the pre-LT evaluation and the emerging role of artificial intelligence models in patients with HCC.
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Affiliation(s)
- Marco Dioguardi Burgio
- Department of Radiology, Hôpital Beaujon, AP-HP. Nord, 100 Boulevard du Général Leclerc, 92110 Clichy, France (V.V.)
- Centre de Recherche sur l’Inflammation, UMR1149, Université Paris Cité, 75018 Paris, France
| | - Lorenzo Garzelli
- Service d’Imagerie Medicale, Centre Hospitalier de Cayenne, Avenue des Flamboyants, Cayenne 97306, French Guiana
| | - Roberto Cannella
- Department of Biomedicine, Neuroscience and Advanced Diagnostics (Bi.N.D.), University Hospital “Paolo Giaccone”, Via del Vespro 129, 90127 Palermo, Italy
| | - Maxime Ronot
- Department of Radiology, Hôpital Beaujon, AP-HP. Nord, 100 Boulevard du Général Leclerc, 92110 Clichy, France (V.V.)
- Centre de Recherche sur l’Inflammation, UMR1149, Université Paris Cité, 75018 Paris, France
| | - Valérie Vilgrain
- Department of Radiology, Hôpital Beaujon, AP-HP. Nord, 100 Boulevard du Général Leclerc, 92110 Clichy, France (V.V.)
- Centre de Recherche sur l’Inflammation, UMR1149, Université Paris Cité, 75018 Paris, France
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Jhaveri KS, Babaei Jandaghi A, Bhayana R, Elbanna KY, Espin-Garcia O, Fischer SE, Ghanekar A, Sapisochin G. Prospective evaluation of Gadoxetate-enhanced magnetic resonance imaging and computed tomography for hepatocellular carcinoma detection and transplant eligibility assessment with explant histopathology correlation. Cancer Imaging 2023; 23:22. [PMID: 36841796 PMCID: PMC9960413 DOI: 10.1186/s40644-023-00532-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2022] [Accepted: 02/08/2023] [Indexed: 02/27/2023] Open
Abstract
BACKGROUND We aimed to prospectively compare the diagnostic performance of gadoxetic acid-enhanced MRI (EOB-MRI) and contrast-enhanced Computed Tomography (CECT) for hepatocellular carcinoma (HCC) detection and liver transplant (LT) eligibility assessment in cirrhotic patients with explant histopathology correlation. METHODS In this prospective, single-institution ethics-approved study, 101 cirrhotic patients were enrolled consecutively from the pre-LT clinic with written informed consent. Patients underwent CECT and EOB-MRI alternately every 3 months until LT or study exclusion. Two blinded radiologists independently scored hepatic lesions on CECT and EOB-MRI utilizing the liver imaging reporting and data system (LI-RADS) version 2018. Liver explant histopathology was the reference standard. Pre-LT eligibility accuracies with EOB-MRI and CECT as per Milan criteria (MC) were assessed in reference to post-LT explant histopathology. Lesion-level and patient-level statistical analyses were performed. RESULTS Sixty patients (49 men; age 33-72 years) underwent LT successfully. One hundred four non-treated HCC and 42 viable HCC in previously treated HCC were identified at explant histopathology. For LR-4/5 category lesions, EOB-MRI had a higher pooled sensitivity (86.7% versus 75.3%, p < 0.001) but lower specificity (84.6% versus 100%, p < 0.001) compared to CECT. EOB-MRI had a sensitivity twice that of CECT (65.9% versus 32.2%, p < 0.001) when all HCC identified at explant histopathology were included in the analysis instead of imaging visible lesions only. Disregarding the hepatobiliary phase resulted in a significant drop in EOB-MRI performance (86.7 to 72.8%, p < 0.001). EOB-MRI had significantly lower pooled sensitivity and specificity versus CECT in the LR5 category with lesion size < 2 cm (50% versus 79%, p = 0.002 and 88.9% versus 100%, p = 0.002). EOB-MRI had higher sensitivity (84.8% versus 75%, p < 0.037) compared to CECT for detecting < 2 cm viable HCC in treated lesions. Accuracies of LT eligibility assessment were comparable between EOB-MRI (90-91.7%, p = 0.156) and CECT (90-95%, p = 0.158). CONCLUSION EOB-MRI had superior sensitivity for HCC detection; however, with lower specificity compared to CECT in LR4/5 category lesions while it was inferior to CECT in the LR5 category under 2 cm. The accuracy for LT eligibility assessment based on MC was not significantly different between EOB-MRI and CECT. TRIAL REGISTRATION ClinicalTrials.gov Identifier: NCT03342677 , Registered: November 17, 2017.
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Affiliation(s)
- Kartik S. Jhaveri
- grid.17063.330000 0001 2157 2938Joint Department of Medical Imaging, University Health Network, Mount Sinai Hospital and Women’s College Hospital, University of Toronto, 610 University Ave, 3-957, Toronto, ON M5G 2M9 Canada
| | - Ali Babaei Jandaghi
- grid.231844.80000 0004 0474 0428Joint Department of Medical Imaging, University Health Network, Mount Sinai Hospital and Women’s College Hospital, Toronto, ON M5G 1X6 Canada
| | - Rajesh Bhayana
- grid.17063.330000 0001 2157 2938Joint Department of Medical Imaging, University Health Network, Mount Sinai Hospital and Women’s College Hospital, University of Toronto, Toronto, ON M5G 2M9 Canada
| | - Khaled Y. Elbanna
- grid.17063.330000 0001 2157 2938Joint Department of Medical Imaging, University Health Network, Mount Sinai Hospital and Women’s College Hospital, University of Toronto, Toronto, ON M5G 2M9 Canada
| | - Osvaldo Espin-Garcia
- grid.415224.40000 0001 2150 066XDepartment of Biostatistics, Princess Margaret Cancer Centre, University Health Network, Toronto, ON M5G 2C1 Canada ,grid.17063.330000 0001 2157 2938Division of Biostatistics, Dalla Lana School of Public Health, University of Toronto, Toronto, Canada
| | - Sandra E. Fischer
- grid.231844.80000 0004 0474 0428Department of Pathology, University Health Network and University of Toronto, Toronto, Ontario Canada
| | - Anand Ghanekar
- grid.17063.330000 0001 2157 2938University Health Network, Department of Surgery, Toronto General Hospital, University of Toronto, Toronto, ON M5G 2N2 Canada
| | - Gonzalo Sapisochin
- grid.17063.330000 0001 2157 2938University Health Network, Department of Surgery, Toronto General Hospital, University of Toronto, Toronto, ON M5G 2N2 Canada
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Lee S, Kim YY, Shin J, Son WJ, Roh YH, Choi JY, Sirlin CB, Chernyak V. Percentages of Hepatocellular Carcinoma in LI-RADS Categories with CT and MRI: A Systematic Review and Meta-Analysis. Radiology 2023; 307:e220646. [PMID: 36625748 DOI: 10.1148/radiol.220646] [Citation(s) in RCA: 9] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
Background The Liver Imaging Reporting and Data System (LI-RADS) CT and MRI algorithm applies equally to CT, MRI with extracellular contrast agents (ECA-MRI), and MRI with gadoxetate (Gx-MRI). Purpose To estimate pooled percentages of hepatocellular carcinoma (HCC) and overall malignancy for each LI-RADS category with CT and MRI. Materials and Methods MEDLINE and EMBASE databases were searched for research articles (January 2014-April 2021) reporting the percentages of observations in each LI-RADS category with use of versions 2014, 2017, or 2018. Study design, population characteristics, imaging modality, reference standard, and numbers of HCC and non-HCC malignancies in each category were recorded. A random-effects model evaluated the pooled percentage of HCC and overall malignancy for each category. Results There were 49 studies with 9620 patients and a total 11 562 observations, comprising 7921 HCCs, 1132 non-HCC malignancies, and 2509 benign entities. No HCC or non-HCC malignancies were reported with any modality in the LR-1 category. The pooled percentages of HCC for CT, ECA-MRI, and Gx-MRI, respectively, were 10%, 6%, and 1% for LR-2 (P = .16); 48%, 31%, and 38% for LR-3 (P = .42); 76%, 64%, and 77% for LR-4 (P = .62); 96%, 95%, and 96% for LR-5 (P = .76); 88%, 76%, and 78% for LR-5V or LR-TIV (tumor in vein) (P = .42); and 20%, 30%, and 35% for LR-M (P = .32). Most LR-M (93%-100%) and LR-5V or LR-TIV (99%-100%) observations were malignant, regardless of modality. Conclusion There was no difference in percentages of hepatocellular carcinoma and overall malignancy between CT, MRI with extracellular contrast agents, and MRI with gadoxetate for any Liver Imaging Reporting and Data System categories. © RSNA, 2023 Supplemental material is available for this article See also the editorial by Ronot in this issue.
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Affiliation(s)
- Sunyoung Lee
- From the Department of Radiology and Research Institute of Radiological Science, Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea (S.L., Y.Y.K., J.S., J.Y.C.); Biostatistics Collaboration Unit, Department of Biomedical Systems Informatics, Yonsei University College of Medicine, Seoul, Republic of Korea (W.J.S., Y.H.R.); Liver Imaging Group, Department of Radiology, University of California San Diego, San Diego, Calif (C.B.S.); and Department of Radiology, Beth Israel Deaconess Medical Center, Boston, Mass (V.C.)
| | - Yeun-Yoon Kim
- From the Department of Radiology and Research Institute of Radiological Science, Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea (S.L., Y.Y.K., J.S., J.Y.C.); Biostatistics Collaboration Unit, Department of Biomedical Systems Informatics, Yonsei University College of Medicine, Seoul, Republic of Korea (W.J.S., Y.H.R.); Liver Imaging Group, Department of Radiology, University of California San Diego, San Diego, Calif (C.B.S.); and Department of Radiology, Beth Israel Deaconess Medical Center, Boston, Mass (V.C.)
| | - Jaeseung Shin
- From the Department of Radiology and Research Institute of Radiological Science, Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea (S.L., Y.Y.K., J.S., J.Y.C.); Biostatistics Collaboration Unit, Department of Biomedical Systems Informatics, Yonsei University College of Medicine, Seoul, Republic of Korea (W.J.S., Y.H.R.); Liver Imaging Group, Department of Radiology, University of California San Diego, San Diego, Calif (C.B.S.); and Department of Radiology, Beth Israel Deaconess Medical Center, Boston, Mass (V.C.)
| | - Won Jeong Son
- From the Department of Radiology and Research Institute of Radiological Science, Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea (S.L., Y.Y.K., J.S., J.Y.C.); Biostatistics Collaboration Unit, Department of Biomedical Systems Informatics, Yonsei University College of Medicine, Seoul, Republic of Korea (W.J.S., Y.H.R.); Liver Imaging Group, Department of Radiology, University of California San Diego, San Diego, Calif (C.B.S.); and Department of Radiology, Beth Israel Deaconess Medical Center, Boston, Mass (V.C.)
| | - Yun Ho Roh
- From the Department of Radiology and Research Institute of Radiological Science, Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea (S.L., Y.Y.K., J.S., J.Y.C.); Biostatistics Collaboration Unit, Department of Biomedical Systems Informatics, Yonsei University College of Medicine, Seoul, Republic of Korea (W.J.S., Y.H.R.); Liver Imaging Group, Department of Radiology, University of California San Diego, San Diego, Calif (C.B.S.); and Department of Radiology, Beth Israel Deaconess Medical Center, Boston, Mass (V.C.)
| | - Jin-Young Choi
- From the Department of Radiology and Research Institute of Radiological Science, Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea (S.L., Y.Y.K., J.S., J.Y.C.); Biostatistics Collaboration Unit, Department of Biomedical Systems Informatics, Yonsei University College of Medicine, Seoul, Republic of Korea (W.J.S., Y.H.R.); Liver Imaging Group, Department of Radiology, University of California San Diego, San Diego, Calif (C.B.S.); and Department of Radiology, Beth Israel Deaconess Medical Center, Boston, Mass (V.C.)
| | - Claude B Sirlin
- From the Department of Radiology and Research Institute of Radiological Science, Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea (S.L., Y.Y.K., J.S., J.Y.C.); Biostatistics Collaboration Unit, Department of Biomedical Systems Informatics, Yonsei University College of Medicine, Seoul, Republic of Korea (W.J.S., Y.H.R.); Liver Imaging Group, Department of Radiology, University of California San Diego, San Diego, Calif (C.B.S.); and Department of Radiology, Beth Israel Deaconess Medical Center, Boston, Mass (V.C.)
| | - Victoria Chernyak
- From the Department of Radiology and Research Institute of Radiological Science, Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea (S.L., Y.Y.K., J.S., J.Y.C.); Biostatistics Collaboration Unit, Department of Biomedical Systems Informatics, Yonsei University College of Medicine, Seoul, Republic of Korea (W.J.S., Y.H.R.); Liver Imaging Group, Department of Radiology, University of California San Diego, San Diego, Calif (C.B.S.); and Department of Radiology, Beth Israel Deaconess Medical Center, Boston, Mass (V.C.)
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Odedra D, Jandaghi AB, Bhayana R, Elbanna KY, Espin-Garcia O, Fischer SE, Ghanekar A, Sapisochin G, Jhaveri KS. Comparison of international guidelines for diagnosis of hepatocellular carcinoma and implications for transplant allocation in liver transplantation candidates with gadoxetic acid enhanced liver MRI versus contrast enhanced CT: a prospective study with liver explant histopathological correlation. Cancer Imaging 2022; 22:55. [PMID: 36195953 PMCID: PMC9531508 DOI: 10.1186/s40644-022-00497-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2022] [Accepted: 09/27/2022] [Indexed: 11/10/2022] Open
Abstract
OBJECTIVES To compare the diagnostic performance of international hepatocellular carcinoma (HCC) guidelines with gadoxetic acid-enhanced MRI (EOB-MRI) and contrast-enhanced Computed tomography (CECT) and their impact on liver transplant (LT) allocation in cirrhotic patients with explant histopathology correlation. METHODS In this prospective single-centre ethics-approved study, 101 cirrhotic patients were consecutively enrolled with informed consent from the pre-LT clinic. They underwent CECT and EOB-MRI alternately at three monthly intervals until LT or removal from LT list. Two abdominal radiologists, blinded to explant histopathology, independently recorded liver lesions visible on CECT and EOB-MRI. Imaging-based HCC scores were assigned to non-treated liver lesions utilizing Liver Imaging Reporting and Data System (LI-RADS), European Association for the Study of the Liver (EASL), Asian-Pacific Association for the Study of the Liver (APASL) and Korean Liver Cancer Association-National Cancer Center (KLCA) guidelines. Liver explant histopathology was the reference standard. Simulated LT eligibility was assessed as per Milan criteria (MC) in reference to explant histopathology. RESULTS One hundred and three non-treated HCC and 12 non-HCC malignancy were identified at explant histopathology in 34 patients (29 men, 5 women, age 55-73 years). Higher HCC sensitivities of statistical significance were observed with EOB-MRI for LI-RADS 4 + 5, APASL and KLCA compared to LI-RADS 5 and EASL with greatest sensitivity obtained for LIRADS 4 + 5 lesions. HCC sensitivities by all guidelines with both EOB-MRI and CECT were significantly lower if all histopathology-detected HCCs were included in the analysis, compared to imaging-visible lesions only. A significantly greater variation in HCC sensitivity was noted across the guidelines with EOB-MRI compared to CECT. No significant differences in simulated LT eligibility based on MC were observed across the HCC scoring guidelines with EOB-MRI or CECT. CONCLUSION HCC sensitivities are variable depending on scoring guideline, lesion size and imaging modality utilised. Prior studies that included only lesions visible on pre-operative imaging overestimate the diagnostic performance of HCC scoring guidelines. Per-lesion differences in HCC diagnosis across these guidelines did not impact patient-level LT eligibility based on MC.
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Affiliation(s)
- Devang Odedra
- Department of Medical Imaging, University Health Network Mount Sinai Hospital and Women's College Hospital, Toronto, ON, Canada
| | - Ali Babaei Jandaghi
- Department of Medical Imaging, University Health Network Mount Sinai Hospital and Women's College Hospital, Toronto, ON, Canada
| | - Rajesh Bhayana
- Department of Medical Imaging, University Health Network Mount Sinai Hospital and Women's College Hospital University of Toronto, Toronto, ON, Canada
| | - Khaled Y Elbanna
- Department of Medical Imaging, University Health Network Mount Sinai Hospital and Women's College Hospital University of Toronto, Toronto, ON, Canada
| | - Osvaldo Espin-Garcia
- Department of Biostatistics, Princess Margaret Cancer Centre, University Health Network, Toronto, ON, Canada.,Department of Epidemiology and Biostatistics, Western University, London, Canada
| | - Sandra E Fischer
- Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, ON, Canada.,Department of Pathology, University Health Network and University of Toronto, Toronto, ON, Canada
| | - Anand Ghanekar
- Department of Surgery, University Health Network and Toronto General Hospital University of Toronto, Toronto, ON, Canada
| | - Gonzalo Sapisochin
- Department of Surgery, University Health Network and Toronto General Hospital University of Toronto, Toronto, ON, Canada
| | - Kartik S Jhaveri
- Department of Medical Imaging, University Health Network Mount Sinai Hospital and Women's College Hospital University of Toronto, Toronto, ON, Canada.
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11
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Öcal O, Zech CJ, Fabritius MP, Loewe C, van Delden O, Vandecaveye V, Gebauer B, Berg T, Sengel C, Bargellini I, Iezzi R, Benito A, Pech M, Gasbarrini A, Sangro B, Malfertheiner P, Ricke J, Seidensticker M. Non-hypervascular hepatobiliary phase hypointense lesions detected in patients with hepatocellular carcinoma: a post hoc analysis of SORAMIC trial to identify risk factors for progression. Eur Radiol 2022; 33:493-500. [PMID: 35881180 DOI: 10.1007/s00330-022-09000-1] [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: 05/20/2022] [Revised: 05/20/2022] [Accepted: 06/29/2022] [Indexed: 12/01/2022]
Abstract
OBJECTIVES To identify clinical and imaging parameters associated with progression of non-hypervascular hepatobiliary phase hypointense lesions during follow-up in patients who received treatment for hepatocellular carcinoma. METHODS A total of 67 patients with 106 lesions were identified after screening 538 patients who underwent gadoxetic acid-enhanced MRI within the SORAMIC trial. All patients were allocated to the trial treatment according to the trial scheme, and 61 of 67 patients received systemic treatment with sorafenib (either alone or combined with locoregional therapies) during the trial period. Follow-up images after treatment according to trial scheme were reviewed for subsequent hypervascularization or > 1 cm size increase. The correlation between progression and several imaging and clinical parameters was assessed using univariable and multivariable analyses. RESULTS On a median 178 (range, 48-1072) days follow-up period, progression was encountered in 18 (16.9%) lesions in 12 (17.9%) patients. In univariable analysis size > 12.6 mm (p = 0.070), ECOG-PS (p = 0.025), hypointensity at T1-weighted imaging (p = 0.028), hyperintensity at T2-weighted imaging (p < 0.001), hyperintensity at DWI images (p = 0.007), and cirrhosis (p = 0.065) were correlated with progression during follow-up. Hyperintensity at T2 images (p = 0.011) was an independent risk factor for progression in multivariable analysis, as well as cirrhosis (p = 0.033) and ECOG-PS (p = 0.030). CONCLUSIONS Non-hypervascular hepatobiliary phase hypointense lesions are associated with subsequent progression after treatment in patients with HCC. T2 hyperintensity, diffusion restriction, cirrhosis, and higher ECOG-PS could identify lesions with increased risk. These factors should be considered for further diagnostic evaluation or treatment of such lesions. KEY POINTS • Non-hypervascular hepatobiliary phase hypointense lesions have considerable risk of progression in patients with hepatocellular carcinoma receiving treatment. • T2 hyperintensity, cirrhosis, ECOG-PS, and hyperintensity at DWI are associated with increased risk of progression. • Non-hypervascular hepatobiliary phase hypointense lesions should be considered in the decision-making process of locoregional therapies, especially in the presence of these risk factors.
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Affiliation(s)
- Osman Öcal
- Department of Radiology, University Hospital, Ludwig Maximilian University of Munich, Marchioninistrasse 15, 81377, Munich, Germany
| | - Christoph J Zech
- Radiology and Nuclear Medicine, University Hospital Basel, University of Basel, Basel, Switzerland
| | - Matthias P Fabritius
- Department of Radiology, University Hospital, Ludwig Maximilian University of Munich, Marchioninistrasse 15, 81377, Munich, Germany
| | - Christian Loewe
- Section of Cardiovascular and Interventional Radiology, Department of Bioimaging and Image-Guided Therapy, Medical University of Vienna, Vienna, Austria
| | - Otto van Delden
- Department of Radiology and Nuclear Medicine, Academic University Medical Centers, University of Amsterdam, Amsterdam, The Netherlands
| | | | - Bernhard Gebauer
- Department of Radiology, Charité - University Medicine Berlin, Berlin, Germany
| | - Thomas Berg
- Klinik und Poliklinik für Gastroenterologie, Sektion Hepatologie, Universitätsklinikum Leipzig, Leipzig, Germany
| | - Christian Sengel
- Radiology Department, Grenoble University Hospital, La Tronche, France
| | - Irene Bargellini
- Department of Vascular and Interventional Radiology, University Hospital of Pisa, Pisa, Italy
| | - Roberto Iezzi
- Fondazione Policlinico Universitario A. Gemelli IRCCS, UOC di Radiologia, Dipartimento di Diagnostica per Immagini, Radioterapia Oncologica ed Ematologia, Rome, Italy
| | - Alberto Benito
- Abdominal Radiology Unit, Department of Radiology, Clínica Universidad de Navarra, Pamplona, Spain
| | - Maciej Pech
- Departments of Radiology and Nuclear Medicine, University of Magdeburg, Magdeburg, Germany
| | - Antonio Gasbarrini
- Fondazione Policlinico Universitario Gemelli IRCCS, Universita' Cattolica del Sacro Cuore, Rome, Italy
| | - Bruno Sangro
- Liver Unit, Clínica Universidad de Navarra and CIBEREHD, Pamplona, Spain
| | | | - Jens Ricke
- Department of Radiology, University Hospital, Ludwig Maximilian University of Munich, Marchioninistrasse 15, 81377, Munich, Germany
| | - Max Seidensticker
- Department of Radiology, University Hospital, Ludwig Maximilian University of Munich, Marchioninistrasse 15, 81377, Munich, Germany.
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12
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Nadarevic T, Colli A, Giljaca V, Fraquelli M, Casazza G, Manzotti C, Štimac D, Miletic D. Magnetic resonance imaging for the diagnosis of hepatocellular carcinoma in adults with chronic liver disease. Cochrane Database Syst Rev 2022; 5:CD014798. [PMID: 35521901 PMCID: PMC9074390 DOI: 10.1002/14651858.cd014798.pub2] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
BACKGROUND Hepatocellular carcinoma occurs mostly in people with chronic liver disease and ranks sixth in terms of global incidence of cancer, and third in terms of cancer deaths. In clinical practice, magnetic resonance imaging (MRI) is used as a second-line diagnostic imaging modality to confirm the presence of focal liver lesions suspected as hepatocellular carcinoma on prior diagnostic test such as abdominal ultrasound or alpha-fetoprotein, or both, either in surveillance programmes or in clinical settings. According to current guidelines, a single contrast-enhanced imaging study (computed tomography (CT) or MRI) showing typical hallmarks of hepatocellular carcinoma in people with cirrhosis is considered valid to diagnose hepatocellular carcinoma. The detection of hepatocellular carcinoma amenable to surgical resection could improve the prognosis. However, a significant number of hepatocellular carcinomas do not show typical hallmarks on imaging modalities, and hepatocellular carcinoma may, therefore, be missed. There is no clear evidence of the benefit of surveillance programmes in terms of overall survival: the conflicting results can be a consequence of inaccurate detection, ineffective treatment, or both. Assessing the diagnostic accuracy of MRI may clarify whether the absence of benefit could be related to underdiagnosis. Furthermore, an assessment of the accuracy of MRI in people with chronic liver disease who are not included in surveillance programmes is needed for either ruling out or diagnosing hepatocellular carcinoma. OBJECTIVES Primary: to assess the diagnostic accuracy of MRI for the diagnosis of hepatocellular carcinoma of any size and at any stage in adults with chronic liver disease. Secondary: to assess the diagnostic accuracy of MRI for the diagnosis of resectable hepatocellular carcinoma in adults with chronic liver disease, and to identify potential sources of heterogeneity in the results. SEARCH METHODS We searched the Cochrane Hepato-Biliary Group Controlled Trials Register, the Cochrane Hepato-Biliary Group Diagnostic Test of Accuracy Studies Register, the Cochrane Library, MEDLINE, Embase, and three other databases to 9 November 2021. We manually searched articles retrieved, contacted experts, handsearched abstract books from meetings held during the last 10 years, and searched for literature in OpenGrey (9 November 2021). Further information was requested by e-mails, but no additional information was provided. No data was obtained through correspondence with investigators. We applied no language or document-type restrictions. SELECTION CRITERIA Studies assessing the diagnostic accuracy of MRI for the diagnosis of hepatocellular carcinoma in adults with chronic liver disease, with cross-sectional designs, using one of the acceptable reference standards, such as pathology of the explanted liver and histology of resected or biopsied focal liver lesion with at least a six-month follow-up. DATA COLLECTION AND ANALYSIS At least two review authors independently screened studies, extracted data, and assessed the risk of bias and applicability concerns, using the QUADAS-2 checklist. We presented the results of sensitivity and specificity, using paired forest plots, and we tabulated the results. We used a hierarchical meta-analysis model where appropriate. We presented uncertainty of the accuracy estimates using 95% confidence intervals (CIs). We double-checked all data extractions and analyses. MAIN RESULTS We included 34 studies, with 4841 participants. We judged all studies to be at high risk of bias in at least one domain because most studies used different reference standards, often inappropriate to exclude the presence of the target condition, and the time interval between the index test and the reference standard was rarely defined. Regarding applicability, we judged 15% (5/34) of studies to be at low concern and 85% (29/34) of studies to be at high concern mostly owing to characteristics of the participants, most of whom were on waiting lists for orthotopic liver transplantation, and due to pathology of the explanted liver being the only reference standard. MRI for hepatocellular carcinoma of any size and stage: sensitivity 84.4% (95% CI 80.1% to 87.9%) and specificity 93.8% (95% CI 90.1% to 96.1%) (34 studies, 4841 participants; low-certainty evidence). MRI for resectable hepatocellular carcinoma: sensitivity 84.3% (95% CI 77.6% to 89.3%) and specificity 92.9% (95% CI 88.3% to 95.9%) (16 studies, 2150 participants; low-certainty evidence). The observed heterogeneity in the results remains mostly unexplained. The sensitivity analyses, which included only studies with clearly prespecified positivity criteria and only studies in which the reference standard results were interpreted without knowledge of the results of the index test, showed no variation in the results. AUTHORS' CONCLUSIONS We found that using MRI as a second-line imaging modality to diagnose hepatocellular carcinoma of any size and stage, 16% of people with hepatocellular carcinoma would be missed, and 6% of people without hepatocellular carcinoma would be unnecessarily treated. For resectable hepatocellular carcinoma, we found that 16% of people with resectable hepatocellular carcinoma would improperly not be resected, while 7% of people without hepatocellular carcinoma would undergo inappropriate surgery. The uncertainty resulting from the high risk of bias in the included studies and concerns regarding their applicability limit our ability to confidently draw conclusions based on our results.
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Affiliation(s)
- Tin Nadarevic
- Department of Radiology, Clinical Hospital Centre Rijeka, Rijeka, Croatia
| | - Agostino Colli
- Department of Transfusion Medicine and Haematology, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milano, Italy
| | - Vanja Giljaca
- Department of Gastroenterology, Heart of England NHS Foundation Trust, Birmingham, UK
| | - Mirella Fraquelli
- Gastroenterology and Endoscopy Unit, Fondazione IRCCS Ca´ Granda - Ospedale Maggiore Policlinico, Milan, Italy
| | - Giovanni Casazza
- Dipartimento di Scienze Biomediche e Cliniche "L. Sacco", Università degli Studi di Milano, Milan, Italy
| | - Cristina Manzotti
- Gastroenterology and Endoscopy Unit, Fondazione IRCCS Ca´ Granda - Ospedale Maggiore Policlinico, Milan, Italy
| | - Davor Štimac
- Department of Gastroenterology, Clinical Hospital Centre Rijeka, Rijeka, Croatia
| | - Damir Miletic
- Department of Radiology , Clinical Hospital Centre Rijeka, Rijeka, Croatia
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13
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Park J, Lee JM, Kim TH, Yoon JH. Imaging Diagnosis of HCC: Future directions with special emphasis on hepatobiliary MRI and contrast-enhanced ultrasound. Clin Mol Hepatol 2021; 28:362-379. [PMID: 34955003 PMCID: PMC9293611 DOI: 10.3350/cmh.2021.0361] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/17/2021] [Accepted: 12/21/2021] [Indexed: 11/16/2022] Open
Abstract
Hepatocellular carcinoma (HCC) is a unique cancer entity that can be noninvasively diagnosed using imaging modalities without pathologic confirmation. In 2018, several major guidelines for HCC were updated to include hepatobiliary contrast agent magnetic resonance imaging (HBA-MRI) and contrast-enhanced ultrasound (CEUS) as major imaging modalities for HCC diagnosis. HBA-MRI enables the achievement of high sensitivity in HCC detection using the hepatobiliary phase (HBP). CEUS is another imaging modality with real-time imaging capability, and it is reported to be useful as a second-line modality to increase sensitivity without losing specificity for HCC diagnosis. However, until now, there is an unsolved discrepancy among guidelines on whether to accept “HBP hypointensity” as a definite diagnostic criterion for HCC or include CEUS in the diagnostic algorithm for HCC diagnosis. Furthermore, there is variability in terminology and inconsistencies in the definition of imaging findings among guidelines; therefore, there is an unmet need for the development of a standardized lexicon. In this article, we review the performance and limitations of HBA-MRI and CEUS after guideline updates in 2018 and briefly introduce some future aspects of imaging-based HCC diagnosis.
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Affiliation(s)
- Junghoan Park
- Department of Radiology, Seoul National University Hospital, 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
| | - Tae-Hyung Kim
- Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, USA
| | - 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
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