Magnetic Resonance Imaging with Gadoxetic Acid Disodium for the Detection of Hepatocellular Carcinoma

Chen, Lihua; Zhang, Lin; Liang, Minglong; Bao, Jing; Zhang, Jiuquan; Xia, Yunbao; Huang, Xuanquan; Wang, Jian

doi:10.1016/j.acra.2014.08.003

Cited by 19 publications

(15 citation statements)

References 45 publications

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“…Restricting our analysis to articles reporting within‐study performance helps mitigate the confounding effects of these variables. Other distinguishing features of our study compared to some meta‐analyses were the inclusion of CT, extracellular agent MRI, and gadoxetate‐MRI and the subanalyses by contrast material and lesion size.…”

Section: Discussionmentioning

confidence: 99%

“…We conducted this systematic review and meta‐analysis to synthesize the existing evidence about the comparative performance of multiphasic CT and MRI with extracellular or gadoxetate contrast in the diagnosis of HCC in patients with underlying cirrhosis. While a number of systematic reviews and meta‐analyses have examined the performance of CT and/or MRI in the diagnosis of HCC, relatively few studies have examined these imaging modalities in comparative studies in which CT was directly compared to either extracellular or partially extracellular and partially hepatocellular contrast agent MRI. A number of the publications included studies that were not directly comparative, and some did not include more recent studies .…”

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confidence: 99%

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Imaging for the diagnosis of hepatocellular carcinoma: A systematic review and meta‐analysis

Roberts¹,

et al. 2017

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Multiphasic computed tomography (CT) and magnetic resonance imaging (MRI) are both used for noninvasive diagnosis of hepatocellular carcinoma (HCC) in patients with cirrhosis. To determine if there is a relative diagnostic benefit of one over the other, we synthesized evidence regarding the relative performance of CT, extracellular contrast-enhanced MRI, and gadoxetate-enhanced MRI for diagnosis of HCC in patients with cirrhosis. We also assessed whether liver biopsy versus follow-up with the same versus alternative imaging is best for CT-indeterminate or MRI-indeterminate liver nodules in patients with cirrhosis. We searched multiple databases from inception to April 27, 2016, for studies comparing CT with extracellular contrast-enhanced MRI or gadoxetate-enhanced MRI in adults with cirrhosis and suspected HCC. Two reviewers independently selected studies and extracted data. Of 33 included studies, 19 were comprehensive, while 14 reported sensitivity only. For all tumor sizes, the 19 comprehensive comparisons showed significantly higher sensitivity (0.82 versus 0.66) and lower negative likelihood ratio (0.20 versus 0.37) for MRI over CT. The specificities of MRI versus CT (0.91 versus 0.92) and the positive likelihood ratios (8.8 versus 8.1) were not different. All three modalities performed better for HCCs 2 cm. Performance was poor for HCCs <1 cm. No studies examined whether adults with cirrhosis and an indeterminate nodule are best evaluated using biopsy, repeated imaging, or alternative imaging. Concerns about publication bias, inconsistent study results, increased risk of bias, and clinical factors precluded support for exclusive use of either gadoxetate-enhanced or extracellular contrast-enhanced MRI over CT. Conclusion: CT, extracellular contrastenhanced MRI, or gadoxetate-enhanced MRI could not be definitively preferred for HCC diagnosis in patients with cirrhosis; in patients with cirrhosis and an indeterminate mass, there were insufficient data comparing biopsy to repeat crosssectional imaging or alternative imaging. (HEPATOLOGY 2018;67:401-421).H epatocellular carcinoma (HCC) is unique among malignancies in having tumor characteristics on cross-sectional multiphasic contrast computed tomography (CT) or magnetic resonance imaging (MRI) that allow for a highly accurate diagnosis of HCC without an invasive biopsy. (1-4) The ability of cross-sectional imaging studies to reliably detect and diagnose HCCs in the cirrhotic liver rests primarily on characterizing the enhancement of a suspected tumor relative to background liver in the hepatic arterial, portal venous, and subsequent phases. (5) The differences in blood flow and extracellular volume between HCC tissues and non-neoplastic cirrhotic liver tissue lead to hallmark imaging characteristics during the multiphasic flow of contrast, including arterial phase hyperenhancement, subsequent washout appearance, and capsule appearance. (6,7) The pathophysiological underpinnings of arterialphase hyperenhancement, washout appearance, and capsule appearance are ...

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Section: Discussionmentioning

confidence: 99%

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confidence: 99%

Imaging for the diagnosis of hepatocellular carcinoma: A systematic review and meta‐analysis

Roberts¹,

et al. 2017

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“…There have been a number of systematic reviews concerned with the diagnosis of HCC by GA‐MRI; however, these reviews either calculated the diagnostic accuracy of GA‐MRI without including a head‐to‐head comparison to existing imaging modalities, or did not separate results for GA‐MRI from other MRI techniques . Wu et al did compare GA‐MRI to CE‐CT in studies published before April 2012 and therefore does not include recently published literature .…”

mentioning

confidence: 99%

“…[2][3][4] In contrast, later stage disease is treated with palliative intent and survival is markedly lower. The median survival rate for intermediate stage HCC (multinodular lesions) following transcatheter arterial chemoembolization (TACE) is 20 months (range 14-45 months) and the median 5-year survival following advanced stage HCC (portal invasion) treated with chemotherapy is 11 months (range [6][7][8][9][10][11][12][13][14]. 2 Less than 30% of HCC patients are eligible for curative procedures at the time of diagnosis 5,6 and hepatic recurrence occurs in more than 50% of patients treated with curative measures.…”

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confidence: 99%

“…Additional hepatobiliary phase images may be obtained if an intracellular agent such as gadoxetic acid (Gd-EOB-DTPA, GA) or gadobenic acid (Gd-BOPTA, GB) is used. 2 There have been a number of systematic reviews concerned with the diagnosis of HCC by GA-MRI [14][15][16][17][18][19] ; however, these reviews either calculated the diagnostic accuracy of GA-MRI without including a head-to-head comparison to existing imaging modalities, 14,[16][17][18] or did not separate results for GA-MRI from other MRI techniques. 15 Wu et al did compare GA-MRI to CE-CT in studies published before April 2012 and therefore does not include recently published literature.…”

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

Duncan

Vreugdenburg

et al. 2016

J. Magn. Reson. Imaging

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Magnetic resonance imaging performed with gadoxetate disodium for the diagnosis of hepatocellular carcinoma in cirrhotic and non-cirrhotic patients

Tang

McInnes

Hope

et al. 2017

Cochrane Database of Systematic Reviews

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Magnetic Resonance Imaging with Gadoxetic Acid Disodium for the Detection of Hepatocellular Carcinoma

Cited by 19 publications

References 45 publications

Imaging for the diagnosis of hepatocellular carcinoma: A systematic review and meta‐analysis

Imaging for the diagnosis of hepatocellular carcinoma: A systematic review and meta‐analysis

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

Magnetic resonance imaging performed with gadoxetate disodium for the diagnosis of hepatocellular carcinoma in cirrhotic and non-cirrhotic patients

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