Prospective Comparison of Gd-EOB-DTPA-Enhanced MRI with Dynamic CT for Detecting Recurrence of HCC after Radiofrequency Ablation

Abstract

Background: We prospectively compared the efficacy of gadolinium-ethoxybenzyl-diethylenetriamine pentaacetic acid (Gd-EOB-DTPA)-enhanced magnetic resonance imaging (MRI) with that of dynamic multidetector computed tomography (MDCT) for detection of recurrent hypervascular hepatocellular carcinoma (HCC) after radiofrequency ablation (RFA). Methods: Institutional review board approval and written informed consent were obtained for this multicenter study. Ninety-seven HCC patients treated with curative RFA underwent both Gd-EOB-DTPA-enhanced MRI and dynamic MDCT every 3-4 months. HCC diagnosis was made based on the typical enhancement pattern of HCC on MRI and/or CT by on-site consensus reading. Two blinded observers independently assessed image datasets to compare diagnostic accuracy, sensitivity, specificity, and the areas under the receiver operating characteristic curve (AUROC). Results: Recurrence was observed in 48 of 97 patients. Among these, 22 were diagnosed by both Gd-EOB-DTPA-enhanced MRI and MDCT; the remainder were diagnosed by only one of these 2 modalities. Recurrence was diagnosed in more patients by Gd-EOB-DTPA-enhanced MRI than by MDCT (44 vs. 26 patients, p < 0.001). Patient-based analysis revealed that the accuracy, sensitivity, and AUROC of Gd-EOB-DTPA-enhanced MRI were significantly higher than those of MDCT for both observers (p < 0.005). The AUROC of Gd-EOB-DTPA- enhanced MRI and MDCT was 0.95 and 0.76 for observer 1 and 0.90 and 0.74 for observer 2, respectively. The κ values for MRI and MDCT were 0.83 and 0.70, respectively. Conclusions: Compared with dynamic MDCT, Gd-EOB-DTPA-enhanced MRI had higher diagnostic accuracy and sensitivity for detection of recurrent hypervascular HCC and may be a better tool for following patients after RFA.

Application of Gd-EOB-DTPA-enhanced magnetic resonance imaging (MRI) in hepatocellular carcinoma

“…However, after radical treatment, patients with early liver cancer have a high intrahepatic recurrence rate, and the survival rate is still not satisfactory [38]. This may be correlated to the failure to detect metastases before the first radical treatment [6]. The detection results of potentially suspicious small HCC lesions would affect the preoperative BCLC staging of some patients.…”

“…When the final diagnosis is made with typical symptoms, the stage of the disease is often advanced [3]. With the exception of some patients who received early diagnosis and prompt surgical resection or liver transplantation, the overall prognosis of HCC remains poor [4], with a median survival time of < year and a 5-year survival rate of < 10% [5], and a high recurrence rate [6]. HCC with a single tumor of ≤ 3.0 cm is usually referred to as small HCC [7].…”

MRI manifestations of hepatic perfusion disorders

“…Following the extensive application of multislice computed tomography (MSCT), CT evaluations of HPD have previously been reported ( 10 ). However, few MRI evaluations of HPD have been reported, which is likely due to the fact that the use of MRI in imaging for evaulating HPD was introduced after CT and MRI is not used as widely as CT in imaging of HPD ( 11 ). However, the features of HPD in MRI imaging have been described in the literature ( 1 ), and it has been reported that MRI imaging maybe used to indicate the characteristics of different hepatic diseases that cause HPD ( 3 ).…”

Recurrence After Curative Resection of Hepatitis B Virus–Related Hepatocellular Carcinoma: Diagnostic Algorithms on Gadoxetic Acid–Enhanced Magnetic Resonance Imaging

“…In the AASLD 2018 practice guidance recommendations, the Liver Imaging Reporting and Data System (LI‐RADS) system was proposed as a radiological hallmark of observations associated with category codes . As a hepatocyte‐specific imaging modality, gadoxetic acid–enhanced MRI shows higher sensitivity for detecting premalignancies or hypervascular recurrences after thermal ablation compared with multiphase CT or MRI with the use of an extracellular contrast agent . According to most studies, current diagnostic algorithms are applicable for characterizing recurrence based on the assumption that the imaging patterns of recurrent HCCs would be the same as those of primary HCCs .…”

“…As a hepatocyte‐specific imaging modality, gadoxetic acid–enhanced MRI shows higher sensitivity for detecting premalignancies or hypervascular recurrences after thermal ablation compared with multiphase CT or MRI with the use of an extracellular contrast agent . According to most studies, current diagnostic algorithms are applicable for characterizing recurrence based on the assumption that the imaging patterns of recurrent HCCs would be the same as those of primary HCCs . Moreover, recurrent HCCs frequently show atypical enhancement patterns, which may lead to additional false‐negative results if stringent diagnostic criteria must be met.…”