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

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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.

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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

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Author information

Authors and Affiliations

  1. BCLC Group, Radiology Department, Hospital Clínic Barcelona, University of Barcelona, Villarroel 170 Escala 3 Planta 1, 08036, Barcelona, Catalonia, Spain

    Jordi Rimola

  2. Department of Radiology, University of Michigan Health System, Ann Arbor, MI, USA

    Jordi Rimola, Matthew S. Davenport, Peter S. Liu & Hero K. Hussain

  3. Abdominal Imaging Imaging Institute, Cleveland Clinic, Cleveland, OH, USA

    Peter S. Liu

  4. Department of Pathology, University of Michigan Health System, Ann Arbor, MI, USA

    Theodore Brown & Barbara J. McKenna

  5. Department of Hepatology, University of Michigan Health System, Ann Arbor, MI, USA

    Jorge A. Marrero

  6. Division of Digestive and Liver Diseases, Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas, TX, USA

    Jorge A. Marrero

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  1. Jordi Rimola
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  4. Theodore Brown
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Correspondence to Jordi Rimola.

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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.

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Rimola, J., Davenport, M.S., Liu, P.S. et al. Diagnostic accuracy of MRI with extracellular vs. hepatobiliary contrast material for detection of residual hepatocellular carcinoma after locoregional treatment. Abdom Radiol 44, 549–558 (2019). https://doi.org/10.1007/s00261-018-1775-x

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