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Abdominal Radiology

, Volume 42, Issue 1, pp 179–190 | Cite as

Hepatocellular carcinoma detection: diagnostic performance of a simulated abbreviated MRI protocol combining diffusion-weighted and T1-weighted imaging at the delayed phase post gadoxetic acid

  • Cecilia Besa
  • Sara Lewis
  • Pari V. Pandharipande
  • Jagpreet Chhatwal
  • Amita Kamath
  • Nancy Cooper
  • Ashley Knight-Greenfield
  • James S. Babb
  • Paolo Boffetta
  • Norma Padron
  • Claude B. Sirlin
  • Bachir TaouliEmail author
Article

Abstract

Purpose

The purpose of this study was to evaluate the diagnostic performance of a “simulated” abbreviated MRI (AMRI) protocol using diffusion-weighted imaging (DWI) and T1-weighted (T1w) imaging obtained at the hepatobiliary phase (HBP) post gadoxetic acid injection alone and in combination, compared to dynamic contrast-enhanced (CE)-T1w imaging for the detection of hepatocellular carcinoma (HCC).

Methods

This was an IRB approved HIPAA compliant retrospective single institution study including patients with liver disease who underwent gadoxetic acid-enhanced MRI for HCC diagnosis. Three independent observers assessed 2 sets of images (full CE-set and AMRI including DWI+T1w-HBP). Diagnostic performance of T1w-HBP and DWI alone and in combination was compared to that of CE-set. All imaging sets included unenhanced T1w and T2w sequences. A preliminary analysis was performed to assess cost savings of AMRI protocol compared to a full MRI study.

Results

174 patients including 62 with 80 HCCs were assessed. Equivalent per-patient sensitivity and negative predictive value (NPV) were observed for DWI (85.5% and 92.2%, pooled data) and T1w-HBP (89.8% and 94.2%) (P = 0.1–0.7), while these were significantly lower for the full AMRI protocol (DWI+T1w-HBP, 80.6% and 80%, P = 0.02) when compared to CE-set (90.3% and 94.9%). Higher specificity and positive predictive value were observed for CE-set vs. AMRI (P = 0.02). The estimated cost reduction of AMRI versus full MRI ranged between 30.7 and 49.0%.

Conclusion

AMRI using DWI and T1w-HBP has a clinically acceptable sensitivity and NPV for HCC detection. This could serve as the basis for a future study assessing AMRI for HCC screening and surveillance.

Keywords

Hepatocellular carcinoma MRI Diffusion-weighted imaging Gadoxetic acid 

Notes

Compliance with Ethical Standards

Conflict of interest

C. B. Sirlin is a consultant to Bayer Healthcare and a member of an advisory board for Bayer Healthcare.

Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

Informed consent

The Institutional Review Board at our institution approved this single-center retrospective study and the need for informed consent was waived.

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Copyright information

© Springer Science+Business Media New York 2016

Authors and Affiliations

  • Cecilia Besa
    • 1
    • 2
  • Sara Lewis
    • 2
  • Pari V. Pandharipande
    • 3
  • Jagpreet Chhatwal
    • 3
  • Amita Kamath
    • 2
  • Nancy Cooper
    • 2
  • Ashley Knight-Greenfield
    • 1
  • James S. Babb
    • 4
  • Paolo Boffetta
    • 5
  • Norma Padron
    • 6
  • Claude B. Sirlin
    • 7
  • Bachir Taouli
    • 1
    • 2
    Email author
  1. 1.Translational and Molecular Imaging InstituteIcahn School of Medicine at Mount SinaiNew YorkUSA
  2. 2.Department of RadiologyIcahn School of Medicine at Mount SinaiNew YorkUSA
  3. 3.Institute for Technology Assessment, Department of RadiologyMassachusetts General HospitalBostonUSA
  4. 4.Department of RadiologyNew York University Langone Medical CenterNew YorkUSA
  5. 5.Division of Cancer Prevention and ControlDepartment of Oncological Sciences, Icahn School of Medicine at Mount SinaiNew YorkUSA
  6. 6.Department of Population Health Science and PolicyIcahn School of Medicine at Mount SinaiNew YorkUSA
  7. 7.Liver Imaging Group, Department of RadiologyUniversity of CaliforniaSan DiegoUSA

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