Gadoxetic acid-enhanced MRI for the characterization of hepatocellular carcinoma: A systematic review and meta-analysis

Use of gadoxetate disodium, a hepatobiliary gadolinium‐based agent, in patients with chronic parenchymal liver disease offers the advantage of improved sensitivity for detecting hepatocellular carcinoma (HCC). Imaging features of liver observations on gadoxetate‐enhanced MRI may also serve as biomarkers of recurrence‐free and overall survival following definitive treatment of HCC. A number of technical and interpretative pitfalls specific to gadoxetate exist, however, and needs to be recognized when protocoling and interpreting MRI exams with this agent. This article reviews the advantages and pitfalls of gadoxetate use in patients at risk for HCC, and the potential impact on Liver Imaging Reporting and Data System (LI‐RADS) imaging feature assessment and categorization. Level of Evidence: 5 Technical Efficacy Stage: 2 J. Magn. Reson. Imaging 2019;49:1236–1252.

Section: Potential Advantages Of Gadoxetatementioning

confidence: 99%

Use of gadoxetate disodium in patients with chronic liver disease and its implications for liver imaging reporting and data system (LI‐RADS)

Chernyak

Fowler

Heiken

et al. 2019

“…An example of a recently published subgroup analysis is presented in Fig. . An alternative is meta‐regression.…”

Section: Updating Systematic Reviewsmentioning

confidence: 99%

“…Systematic reviews, when well reported and performed with methodological rigor, represent valuable summaries of existing evidence about risk factors for specific medical conditions, the effectiveness of interventions, or the performance of medical tests . The Cochrane Collaboration defines a systematic review as “a review of the evidence on a clearly formulated question that uses systematic and explicit methods to identify, select and critically appraise relevant primary research, and to extract and analyze data from the studies that are included in the review.”…”

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confidence: 99%

“…Systematic reviews can be used to aggregate data from multiple relatively small or underpowered studies to provide a more precise and more informative estimate of the effectiveness of an intervention or the accuracy of a diagnostic test . Additionally, meta‐analysis may explore sources of heterogeneity among the observed effects of an intervention or the accuracy of a diagnostic test …”

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confidence: 99%

“…Magnetic resonance imaging (MRI) is a powerful diagnostic tool and with a wide array of clinical, mainly diagnostic, applications . While MRI‐guided procedures (interventional MRI) began in the 1990s, image‐guided interventions are still dominated by ultrasound, fluoroscopy, and computed tomography (CT) .…”

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confidence: 99%

See 2 more Smart Citations

Best practices for MRI systematic reviews and meta‐analyses

McGrath

Bossuyt

Cronin

et al. 2018

View‐Sharing Artifact Reduction With Retrospective Compressed Sensing Reconstruction in the Context of Contrast‐Enhanced Liver MRI for Hepatocellular Carcinoma (HCC) Screening

Shaikh

Stoddard

Levine

et al. 2018

Background: View-sharing (VS) increases spatiotemporal resolution in dynamic contrast-enhanced (DCE) MRI by sharing high-frequency k-space data across temporal phases. This temporal sharing results in respiratory motion within any phase to propagate artifacts across all shared phases. Compressed sensing (CS) eliminates the need for VS by recovering missing k-space data from pseudorandom undersampling, reducing temporal blurring while maintaining spatial resolution. Purpose: To evaluate a CS reconstruction algorithm on undersampled DCE-MRI data for image quality and hepatocellular carcinoma (HCC) detection. Study Type: Retrospective. Subjects: Fifty consecutive patients undergoing MRI for HCC screening (29 males, 21 females, 52-72 years). Field Strength/Sequence: 3.0T MRI. Multiphase 3D-SPGR T 1 -weighted sequence undersampled in arterial phases with a complementary Poisson disc sampling pattern reconstructed with VS and CS algorithms. Assessment: VS and CS reconstructions evaluated by blinded assessments of image quality and anatomic delineation on Likert scales (1-4 and 1-5, respectively), and HCC detection by OPTN/UNOS criteria including a diagnostic confidence score (1-5). Blinded side-by-side reconstruction comparisons for lesion depiction and overall series preference (-3-3). Statistical Analysis: Two-tailed Wilcoxon signed rank tests for paired nonparametric analyses with Bonferroni-Holm multiple-comparison corrections. McNemar's test for differences in lesion detection frequency and transplantation eligibility. Results: CS compared with VS demonstrated significantly improved contrast (mean 3.6 vs. 2.9, P < 0.0001) and less motion artifact (mean 3.6 vs. 3.2, P = 0.006). CS compared with VS demonstrated significantly improved delineations of liver margin (mean 4.5 vs. 3.8, P = 0.0002), portal veins (mean 4.5 vs. 3.7, P < 0.0001), and hepatic veins (mean 4.6 vs. 3.5, P < 0.0001), but significantly decreased delineation of hepatic arteries (mean 3.2 vs. 3.7, P = 0.004). No significant differences were seen in the other assessments. Data Conclusion: Applying a CS reconstruction to data acquired for a VS reconstruction significantly reduces motion artifacts in a clinical DCE protocol for HCC screening. Level of Evidence: 3 Technical Efficacy: Stage 2 J. MAGN. RESON. IMAGING 2019;49:984-993. View this article online at wileyonlinelibrary.com.