Hepatocellular Carcinoma in Patients with Cirrhosis: Qualitative Comparison of Gadobenate Dimeglumine–enhanced MR Imaging and Multiphasic 64-Section CT

Marin, Daniele; Martino, Michele Di; Guerrisi, Antonino; Filippis, Gianmaria De; Rossi, Massimo; Corradini, Stefano Ginanni; Masciangelo, Raffaele; Catalano, Carlo; Passariello, Roberto

doi:10.1148/radiol.2511080400

Cited by 89 publications

(61 citation statements)

References 30 publications

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“…20,22 Previous studies showed improved diagnostic sensitivity/ PPV by adding HP images to dynamic MR imaging or by comparing them with CECT. 7,8,20,[23][24][25] Our results agreed with those of the previous studies. Using hypointensity as a major feature, we can more effectively categorize a hypovascular HCC of at least grade LR3.…”

Section: Discussionsupporting

confidence: 93%

Added Value of a Gadoxetic Acid-enhanced Hepatocyte-phase Image to the LI-RADS System for Diagnosing Hepatocellular Carcinoma

et al. 2016

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Purpose: We investigated the added value of the hypointensity on hepatocyte-phase (HP) imaging of gadoxetic acid-enhanced MRI (EOB-MRI) in the 2014 version of the Liver Imaging Reporting and Data System (LI-RADS) for distinguishing hepatocellular carcinoma (HCC) from benign hepatic lesions in patients with chronic liver disease.Methods: We retrospectively evaluated targeted lesions (111 HCCs, 28 benign hepatic lesions) of 139 patients (101 men, 38 women; aged 18 to 89 years, mean age, 68 « 11 years) with chronic liver disease. EOB-MRI and dynamic contrast-enhanced computed tomography (CECT) were performed within 3 months. Two abdominal radiologists independently reviewed 3 imaging datasets: (1) EOB-MRI without an HP image using the LI-RADS system (MR imaging without HP); (2) EOB-MRI with an HP image using a modified version of the LI-RADS system in which hypointensity on the HP image was used as an additional major criterion of malignancy (MR imaging with HP); and (3) dynamic contrast-enhanced computed tomography (CECT) images using the LI-RADS system. We evaluated intra-and inter-reader agreement with kappa statistics along with 95% confidence intervals and compared diagnostic sensitivity and specificity of the 3 imaging datasets with McNemar's test.Results Conclusion: The use of an HP image from EOB-MRI as an additional major criterion improved the sensitivity of LI-RADS to distinguish HCCs from benign hepatic lesions while retaining high specificity.

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Section: Discussionsupporting

confidence: 93%

Added Value of a Gadoxetic Acid-enhanced Hepatocyte-phase Image to the LI-RADS System for Diagnosing Hepatocellular Carcinoma

et al. 2016

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“…Third, to minimize false categorization in evaluating responses, 2 independent radiologists interpreted radiologic responses and final classifications made by consensus between them were ultimately adopted. In our study, the high levels of concordance between the 2 readers were observed compared with other literatures (22)(23)(24). This is most likely because radiologists assessed responses using the given number of target lesions (i.e., up to 1 target, up to 2 targets, and so on) according to the main concept of this study.…”

Section: Discussionsupporting

confidence: 50%

Number of Target Lesions for EASL and Modified RECIST to Predict Survivals in Hepatocellular Carcinoma Treated with Chemoembolization

Kim

Kim²,

Kim³

et al. 2013

Clinical Cancer Research

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Purposes: To date, most studies about the optimal number of target lesions for enhancement criteria for hepatocellular carcinoma (HCC) have focused on cross-sectional analyses of concordance. We investigated the optimal number of target lesions for European Association for the Study of the Liver (EASL) and modified Response Evaluation Criteria in Solid Tumors (mRECIST) guidelines in predicting overall survival (OS).Experimental Design: We analyzed 254 consecutive treatment-na€ ve patients with HCC having at least 2 measurable target lesions undergoing transarterial chemoembolization. Kappa values for intermethod agreement of treatment responses were calculated for comparisons between use of maximum of 1, 2, 3, 4, or 5 targets versus use of all target lesions. Prognostic values of radiologic assessments according to number of target lesions for predicting OS were expressed as C-index.Results: By EASL and mRECIST guidelines, k values between responses assessing the longest 2, 3, 4, or 5 targets and assessing all targets were 0.924, 0.977, 1.000, or 1.000 and 0.907, 0.959, 1.000, or 1.000, respectively, whereas those between responses assessing only one target and assessing all target lesions were 0.723 and 0.666, respectively. C-index when measuring the longest 1, 2, 3, 4, 5, and all targets was similar, ranging from 0.739 to 0.749 for EASL criteria and from 0.750 to 0.759 for mRECIST. From Cox regression analyses, radiologic response from each calculation method showed independently significant effects on OS for both guidelines, regardless of number of target lesions.Conclusions: Prognostic values for predicting OS were similar regardless of number of target lesions. Assessing the 2 largest targets rather than only 1 index lesion could be recommended considering high concordances from cross-sectional analyses.

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“…Marin et al [41] demonstrated that EOB-MRI with the combined interpretation of dynamic triple-phase MRI and HBP-MRI significantly improved the sensitivity of HCC detection (72%) compared with either dynamic MRI (63%) or MDCT images alone (61%; p = 0.008 and 0.001, respectively). This result was even more valuable for lesions 1-2 cm in diameter.…”

Section: European Literaturementioning

confidence: 99%

“…Unfortunately, the Western guidelines have not advanced in the same way as the above-mentioned European literature [41,42,43,44,45]; neither the AASLD [7,55] nor EASL-EORTC guidelines [6,8] have included EOB-MRI in the diagnostic flowchart and in the follow-up, and they also do not acknowledge the diagnostic superiority of dynamic MRI over MDCT, which has been widely demonstrated [41,42]. On the other hand, the Italian Association for the Study of the Liver recommendations [56] recognizes these topics and introduces some statements, such as ‘multiphasic MRI with hepatocyte-specific contrast medium may provide additional clues to the diagnosis of HCC and is superior to CT for intrahepatic staging of the tumor' and ‘intrahepatic staging of HCC should be assessed by MRI whenever the patient appears to be a potential candidate for surgical or ablative treatment, as this radiological technique is more accurate than CT'.…”

Section: East-west Differencesmentioning

confidence: 99%

Focal Lesions in the Cirrhotic Liver: Their Pivotal Role in Gadoxetic Acid-Enhanced MRI and Recognition by the Western Guidelines

Golfieri

Garzillo

Ascanio

et al. 2014

Dig Dis

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Hepatocellular carcinoma (HCC) is a major health concern, and early HCC diagnosis is a primary radiological concern. The goal of imaging liver cirrhosis is the early identification of high-grade dysplastic nodules/early HCC since their treatment is associated with a higher chance of radical cure and lower recurrence rates. The newly introduced MRI contrast agent gadoxetic acid (gadolinium-ethoxybenzyl-diethylenetriamine pentaacetic acid, Gd-EOB-DTPA) has enabled the concurrent assessment of tumor vascularity and hepatocyte-specific contrast enhancement during the hepatobiliary phase (HBP), which can help to detect and characterize smaller HCCs and their precursors. HBP-EOB-MRI identifies hypovascular HCC nodules that are difficult to detect using ultrasonography or computed tomography, which do not show the diagnostic HCC hallmarks of arterial washin and portal/delayed washout. During the HBP, typical HCC and early HCC appear hypointense on EOB-MRI, whereas low-grade dysplastic or regenerative nodules appear as iso- or hyperintense lesions. The diagnostic accuracy of EOB-MRI for the diagnosis of early HCC is approximately 95-100%. One third of hypovascular hypointense nodules in HBP become hypervascular ‘progressed' HCC, with a 1- and 3-year cumulative incidence of 25 and 41%, respectively. Therefore, these hypovascular nodules should be strictly followed up or definitely treated as typical HCC. Due to this capability of identifying the precursors and biological behavior of HCC, EOB-MRI has rapidly become a key imaging tool for the diagnosis of HCC and its precursors, despite the scarce MRI availability throughout Europe. With increasing experience, EOB-MRI may eventually be established as the diagnostic imaging modality of choice in this setting. Full recognition by the Western EASL-AASLD guidelines is expected.

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Hepatocellular Carcinoma in Patients with Cirrhosis: Qualitative Comparison of Gadobenate Dimeglumine–enhanced MR Imaging and Multiphasic 64-Section CT

Abstract: The combined interpretation of dynamic and hepatobiliary phase MR images improves diagnostic accuracy of gadobenate dimeglumine-enhanced MR imaging for the detection of HCC compared with either dynamic MR or multiphasic multidetector CT images alone.

Cited by 89 publications

References 30 publications

Added Value of a Gadoxetic Acid-enhanced Hepatocyte-phase Image to the LI-RADS System for Diagnosing Hepatocellular Carcinoma

Added Value of a Gadoxetic Acid-enhanced Hepatocyte-phase Image to the LI-RADS System for Diagnosing Hepatocellular Carcinoma

Number of Target Lesions for EASL and Modified RECIST to Predict Survivals in Hepatocellular Carcinoma Treated with Chemoembolization

Focal Lesions in the Cirrhotic Liver: Their Pivotal Role in Gadoxetic Acid-Enhanced MRI and Recognition by the Western Guidelines

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