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Diagnostic accuracy of MRI with extracellular vs. hepatobiliary contrast material for detection of residual hepatocellular carcinoma after locoregional treatment

  • Jordi Rimola
  • Matthew S. Davenport
  • Peter S. Liu
  • Theodore Brown
  • Jorge A. Marrero
  • Barbara J. McKenna
  • Hero K. Hussain
Article
  • 32 Downloads

Abstract

Purpose

To compare the diagnostic accuracy of extracellular gadolinium-based contrast-enhanced MRI (Gd-MRI) and gadoxetic acid-enhanced MRI (EOB-MRI) for the assessment of hepatocellular carcinoma (HCC) response to locoregional therapy (LRT) using explant correlation as the reference standard.

Methods

Forty-nine subjects with cirrhosis and HCC treated with LRT who underwent liver MRI using either Gd-MRI (n = 26) or EOB-MRI (n = 23) within 90 days of liver transplantation were included. Four radiologists reviewed the MR images blinded to histology to determine the size and percentage of viable residual HCC using a per-lesion explant reference standard. Sensitivities, specificities, accuracies, and agreement with histology for the detection residual HCC were calculated.

Results

Gd-MRI had greater agreement with histology (ICC: 0.98 [0.95–0.99] vs. 0.80 [0.63–0.90]) and greater sensitivity for viable HCC (76% [13/17 50–93%] vs. 58% [7/12; 28–85%]) than EOB-MRI; specificities were similar (84% [16/19; 60–97%] vs. 85% [23/27; 66–96%]). Areas under ROC curves for detecting residual viable tumor were 0.80 (0.64–0.92) for Gd-MRI and 0.72 (0.55–0.85) for EOB-MRI. Gd-MRI had greater inter-rater agreement than EOB-MRI for determining the size of residual viable HCC (ICC: 0.96 [0.92–0.98] vs. 0.85 [0.72–0.92]).

Conclusion

Gd-MRI may be more accurate and precise than EOB-MRI for the assessment of viable HCC following LRT.

Keywords

Hepatocellular carcinoma Liver Magnetic resonance imaging Radiofrequency ablation Trans-arterial chemoembolization 

Abbreviations

HCC

Hepatocellular carcinoma

MR

Magnetic resonance

Gd-MRI

Gadolinium-based contrast-enhanced MRI

EOB-MRI

Gadoxetic acid-enhanced MRI

LRT

Locoregional treatment

ROC

Receiver operator characteristics

RFA

Radiofrequency ablation

TACE

Trans-arterial chemoembolization

EASL

European Association for the Study of the Liver

Notes

Compliance with ethical standards

Funding

Jordi Rimola was partially supported by a grant from Fundación Alfonso Martín Escudero.

Conflict of interest

The authors of this manuscript declare no relationships with any companies, whose products or services may be related to the subject matter of the article.

Ethical approval

Institutional Review Board approval was obtained. Written informed consent was waived by the Institutional Review Board. This article does not contain any studies with animals performed by any of the authors.

Supplementary material

261_2018_1775_MOESM1_ESM.docx (20 kb)
Supplementary material 1 (DOCX 19 kb)

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Copyright information

© Springer Science+Business Media, LLC, part of Springer Nature 2018

Authors and Affiliations

  1. 1.BCLC Group, Radiology Department, Hospital Clínic BarcelonaUniversity of BarcelonaBarcelonaSpain
  2. 2.Department of RadiologyUniversity of Michigan Health SystemAnn ArborUSA
  3. 3.Abdominal Imaging Imaging InstituteCleveland ClinicClevelandUSA
  4. 4.Department of PathologyUniversity of Michigan Health SystemAnn ArborUSA
  5. 5.Department of HepatologyUniversity of Michigan Health SystemAnn ArborUSA
  6. 6.Division of Digestive and Liver Diseases, Department of Internal MedicineUniversity of Texas Southwestern Medical CenterDallasUSA

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