The Diagnostic Performance of Liver MRI without Intravenous Contrast for Detecting Hepatocellular Carcinoma: A Case-Controlled Feasibility Study

Abstract

ObjectiveTo preliminarily evaluate the diagnostic performance of an unenhanced MRI for detecting hepatocellular carcinoma (HCC) with a case-control study design.Materials and MethodsThe case group consisted of 175 patients with initially-diagnosed HCC, who underwent a 3T liver MRI. A total of 237 HCCs were identified. The number of HCCs that were smaller than 1 cm, 1 cm ≤ and < 2 cm, and ≥ 2 cm were 19, 105, and 113, respectively. For the control group, 72 patients with chronic liver disease, who did not have HCC, were enrolled. Two radiologists independently reviewed the T2 half-Fourier acquisition single-shot turbo spin echo, T2 fast spin echos with fat saturation, T1 gradient in- and out-of-phase images, and diffusion-weighted images/apparent diffusion coefficient maps to detect HCC. Per-patient analyses were performed to evaluate the sensitivity and specificity of the non-contrast MRI for diagnosing HCC. Furthermore, the per-lesion sensitivity was also calculated according to tumor size.ResultsIn the per-patient analyses, the sensitivity and specificity of reader 1 were 86.3% (151/175) and 87.5% (63/72), respectively; while those of reader 2 were 82.9% (145/175) and 76.4% (55/72), respectively. When excluding HCCs smaller than 1 cm, the sensitivity of reader 1 and 2 were 88.0% (147/167) and 86.2% (144/167), respectively. In the per-lesion analyses, the sensitivities of reader 1 and reader 2 were 75.9% (180/237) and 70.5% (167/237), respectively.ConclusionThe per-patient sensitivity and specificity of non-contrast MRIs were within a reasonable range for the initial diagnosis of HCC. Non-contrast MRIs may have a potential for surveillance of HCC. Further confirmatory diagnostic test accuracy studies are needed.

Liver Magnetic Resonance Imaging for Hepatocellular Carcinoma Surveillance

“…and 76.4-87.5%, respectively. 21,23 For EOB-AMRI, the sensitivity and specificity ranged from 80.6-83.7% and 90.6-91.6%, respectively. 19,22 Although these were heterogeneous studies carried out at different centers, all showed promising results for AMRI as a screening tool for HCC.…”

“…AMRI can be primarily divided into three categories (Table 1): noncontrast AMRI, HBP added to noncontrast AMRI (EOB-AMRI), and dynamic AMRI using an ECCM. [19][20][21][22][23] In prior studies, two to five key sequences were selected for each AMRI protocol to yield a fairly high per-patient sensitivity of 80-89.6% for the diagnosis of HCC. [19][20][21][22][23][24] Particularly, for noncontrast AMRI, the perpatient sensitivity and specificity ranged from 82.9-89.6%…”

“…2). 21 There is an ongoing prospective, multicenter clinical trial evaluating the use of noncontrast AMRI as an HCC surveillance tool in patients with liver cirrhosis in South Korea. 26 The study aims to assess the detection rate of HCC using US at 6-months intervals compared to yearly noncontrast liver MRI over a 3-years follow-up.…”

Diffusion-Weighted Magnetic Resonance Imaging in Hepatocellular Carcinoma as a Predictor of a Response to Cisplatin-Based Hepatic Arterial Infusion Chemotherapy

“…A 3-T MR system (verio, Siemens Healthcare, Erlangen, Germany) alongside a phased array coil with 8 channels serving as the receiver coil was employed for MR imaging. Breath-hold half Fourier Acquisition single-shot turbo spin echo, respiratory-triggered fast spin echo T2-weighted image with fat suppression and 3D T1-weighted in-and opposed-phase gradient echo with two-point Dixon reconstruction were obtained as previously described [16].…”

Alternative approach of hepatocellular carcinoma surveillance: abbreviated MRI

“…Motivated to provide higher sensitivity than US while avoiding the limitations of CT and conventional MRI, investigators have developed abbreviated MRI (AMRI) protocols that rely on a small number of select sequences specifically tailored for HCC detection [12,[23][24][25][26][27][28][29][30][31][32][33][34][35][36] . The rationale is that reduced scanner time decreases costs and complexity, while improving patient comfort, without significantly compromising HCC detection.…”