Gadolinium-Enhanced MRI for Tumor Surveillance Before Liver Transplantation: Center-Based Experience

Lauenstein, Thomas C.; Salman, Khalil; Morreira, R.; Heffron, Thomas G.; Spivey, James R.; Martínez, Enrique; Sharma, Puneet; Martín, Diego R.

doi:10.2214/ajr.07.2171

Cited by 50 publications

(40 citation statements)

References 34 publications

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“…The major improvement in results coincided with the implementation of the Milan tumor selection criteria [16,17]. The adoption of the Milan criteria is considered to improve survival by selecting patients with lower tumor burdens and thus better tumor differentiation and better tumor biology [16].…”

Section: Discussionmentioning

confidence: 97%

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Liver transplantation for hepatocellular carcinoma: the Baylor experience

Onaca

Klintmalm

2009

J Hepato Biliary Pancreat

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Results Of 2350 patients who underwent primary LTX, 330 had HCC. Five-year patient survival for HCC patients was 28.6% in 1987-1992 and 42.3% in 1992-1997, which was 41.4-31.4% lower than that in non-HCC patients (P \ 0.0001). After 1997, 5-year survival was 76% for HCC patients, similar to the survival for non-HCC patients (P = 0.8784). Five-year tumor recurrence dropped from 52. 9% (1987-1992) and 48.2% (1992-1997) to 11.4% (1997-2002) and 8.4% (2002-2007) (P \ 0.0001). Multivariate analysis for tumor recurrence showed the following significant factors: tumor size [6 cm [hazard ratio (HR) 3.67], C5 nodules (HR 3.441), vascular invasion (HR 3.18), transplant in 1987-1992 (HR 6.772), and transplant in 1992-1997. MELD-based liver allocation reduced median waiting time for LTX for HCC versus non-HCC (35 vs. 111 days; P = 0.005) without compromise in patient outcome. Conclusions The results of LTX for HCC continue to improve and are equal to results in patients without HCC.

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Section: Discussionmentioning

confidence: 97%

“…This should theoretically have resulted in worse outcomes. However, at the same time, there was a decrease in incidental tumors, due to improved pretransplant HCC screening and improvements in imaging [17,18], as well as the introduction of neoadjuvant treatments for known tumors.…”

Section: Discussionmentioning

confidence: 99%

Liver transplantation for hepatocellular carcinoma: the Baylor experience

Onaca

Klintmalm

2009

J Hepato Biliary Pancreat

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“…Any developing method that is proposed to improve HCC detection rate should be compared against the reference standard of optimized, dynamic T1-weighted GRE with individually tailored arterial phase timing, which has shown sensitivities and specificities of >90%-95% in the peer-reviewed literature (15,(30)(31)(32).…”

Section: Diffusion-weighted Imagingmentioning

confidence: 99%

MRI of hepatocellular carcinoma: an update of current practices

Arif-Tiwari

Kalb

Chundru

et al. 2014

Diagn Interv Radiol

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Hepatocellular carcinoma (HCC) is one of the most common cancers worldwide, and liver transplantation is the optimal treatment for selected patients with HCC and chronic liver disease (CLD). Accurate selection of patients for transplantation is essential to maximize patient outcomes and ensure optimized allocation of donor organs. Magnetic resonance imaging (MRI) is a powerful tool for the detection, characterization, and staging of HCC. In patients with CLD, the MRI findings of an arterial-enhancing mass with subsequent washout and enhancing capsule on delayed interstitial phase images are diagnostic for HCC. Major organizations with oversight for organ donor distribution, such as The Organ Procurement and Transplantation Network (OPTN), accept an imaging diagnosis of HCC, no longer requiring tissue biopsy. In patients that are awaiting transplantation, or are not candidates for liver transplantation, localized therapies such as transarterial chemoembolization and radiofrequency ablation may be offered. MRI can be used to monitor treatment response. The purpose of this review article is to describe the role of imaging methods in the diagnosis, staging, and follow-up of HCC, with particular emphasis on established and evolving MRI techniques employing nonspecific gadolinium chelates, hepatobiliary contrast agents, and diffusion weighted imaging. We also briefly review the recently developed Liver Imaging Reporting and Data System (LI-RADS) formulating a standardized terminology and reporting structure for evaluation of lesions detected in patients with CLD.H epatocellular carcinoma (HCC) is a major worldwide health concern; it is the sixth most common cancer and third leading cause of overall cancer-related mortality. HCC frequently presents as a rapidly growing tumor and has historically been associated with poor prognosis and outcomes. However, tumor screening protocols in high risk patients can lead to an earlier detection of treatable disease. Screening for HCC has resulted in significant improvements in the one-year cause-specific survival rates for new patients (1), and this is directly attributed to improved survival through the detection of early stage tumor.The five-year cumulative risk of HCC ranges from 4%-30% in patients with chronic liver disease (CLD) and cirrhosis (2-3). Multiple therapeutic strategies are available for the treatment of HCC, including medical therapy, percutaneous tumor ablation, transarterial embolic therapy, surgical resection, and liver transplantation. Of all the available methods, liver transplantation is the most effective treatment for early HCC because this method removes not only the tumor but also the entire cirrhotic liver, which is at an increased risk for developing metachronous tumors. The effectiveness of liver transplantation depends upon detecting early stage disease within specific criteria. A seminal paper by Mazzaferro et al. (4), published in 1996, established the "Milan criteria" as the most widely used guidelines for transplant eligibility. The Mila...

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“…Mostly, gadolinium-chelates are used for MRI, but hepatocyte-targeted and reticolo-endothelial system-targeted compounds are also used. Many studies have been published on the sensitivity and specificity of MRI imaging for diagnosis of HCC [3,42,54,55,57,58,60,[66][67][68][69][70][71][72] . Among studies with liver explant correlation, the sensitivity, specificity and positive predictive value ranged from 33% Andreana L et al .…”

Section: Mrimentioning

confidence: 99%

“…Among studies with liver explant correlation, the sensitivity, specificity and positive predictive value ranged from 33% Andreana L et al . Hepatocellular cancer: Imaging, histology and serum markers to 83%, from 57.1% to 100% and from 42.3% to 100% respectively [3,54,55,57,58,60,66,67,[69][70][71][72] . Studies which evaluated the sensitivity of MRI in detecting HCC, using only liver biopsy or clinical and radiological findings as gold standard, have shown an overall sensitivity, specificity and positive predictive value of 77.3% to 94.3%, 96.6% and of 92.6% to 97% respectively [42,56,68] .…”

Section: Mrimentioning

confidence: 99%

Surveillance and diagnosis of hepatocellular carcinoma in patients with cirrhosis

Andreana

Isgrò²,

Pleguezuelo³

et al. 2009

WJH

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Early identification of hepatocellular carcinoma (HCC) is more frequent because of surveillance programs for HCC worldwide. The optimal strategy of surveillance in cirrhosis is a current topical issue. In terms of diagnosis, recent advances in non-invasive imaging technology, including various techniques of harmonic ultrasound, new ultrasound contrast agents, multislice helical computed tomography and rapid high quality magnetic resonance, have all improved the accuracy of diagnosis. Consequently the role of liver biopsy in diagnosis of HCC has declined. The imaging diagnosis relies on the hallmark of arterial hypervascularity with portal venous washout. However, with recent advances in genomics and proteomics a great number of potential serum and tissue markers have been identified and are being developed as new candidate markers for both diagnosis and prognosis of hepatocellular carcinoma, and may increase the need for liver biopsy.

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Gadolinium-Enhanced MRI for Tumor Surveillance Before Liver Transplantation: Center-Based Experience

Cited by 50 publications

References 34 publications

Liver transplantation for hepatocellular carcinoma: the Baylor experience

Liver transplantation for hepatocellular carcinoma: the Baylor experience

MRI of hepatocellular carcinoma: an update of current practices

Surveillance and diagnosis of hepatocellular carcinoma in patients with cirrhosis

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