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Abdominal Radiology

, Volume 43, Issue 7, pp 1627–1633 | Cite as

Evaluation of an abbreviated screening MRI protocol for patients at risk for hepatocellular carcinoma

  • Jennifer Y. Lee
  • Eugene J. Huo
  • Stefanie Weinstein
  • Charmaine Santos
  • Alexander Monto
  • Carlos U. Corvera
  • Judy Yee
  • Thomas A. Hope
Article

Abstract

Purpose

In this study, we compare an abbreviated screening MRI protocol (aMRI), utilizing only dynamic contrast-enhanced images, to a conventional liver MRI (cMRI) for the characterization of observations in at-risk patients.

Materials and methods

164 consecutive HCC screening MRIs were retrospectively analyzed. Two sets of de-identified image sets were created: one with all acquired sequences including T2- and diffusion-weighted sequences (cMRI), and one with only T1-weighted precontrast and dynamic post-contrast images utilizing an extracellular gadolinium contrast agent (aMRI). Three readers assigned a LI-RADS score based on the lesion with the highest LI-RADS category using the aMRI and cMRI datasets during separate reads.

Results

There was no change between the aMRI and cMRI LI-RADS categorization in 93%, 96%, and 96% of cases for readers 1, 2, and 3, respectively. In the majority of the discrepant cases, the score increased from LI-RADS 3 to LI-RADS 4 due to the presence of ancillary features on T2 and DWI. Kappa values for interobserver variability demonstrated fair-to-moderate LI-RADS agreement among the 3 readers.

Conclusion

There was strong agreement between the abbreviated T1-only MRI protocol and a full liver MRI, with only 5% of cases changing LI-RADS categorization due to the inclusion of T2 and DWI. The estimated time to run this abbreviated MRI is approximately 7–10 min, possibly allowing for a more cost-effective screening MRI than our cMRIs.

Keywords

Hepatocellular carcinoma MRI Screening LI-RADS 

Notes

Compliance with ethical standards

Conflict of interest

Jennifer Y. Lee, Eugene J. Huo, Stefanie Weinstein, Charmaine Santos, Alexander Monto, Carlos U. Corvera, Judy Yee and Thomas A. Hope declare that they have no conflict of interest.

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 need for individual informed consent was waived by our institutional review board (IRB) for this retrospective study.

References

  1. 1.
    Stewart BW, Wild C (2014) World cancer report 2014. Lyon: International Agency for Research on CancerGoogle Scholar
  2. 2.
    Andersson KL, Salomon JA, Goldie SJ, Chung RT (2008) Cost effectiveness of alternative surveillance strategies for hepatocellular carcinoma in patients with cirrhosis. Clin Gastroenterol Hepatol 6:1418–1424CrossRefPubMedPubMedCentralGoogle Scholar
  3. 3.
    Colli A, Fraquelli M, Casazza G, et al. (2006) Accuracy of ultrasonography, spiral CT, magnetic resonance, and alpha-fetoprotein in diagnosing hepatocellular carcinoma: a systematic review. CME. Am J Gastroenterol 101:513–523CrossRefPubMedGoogle Scholar
  4. 4.
    Bruix J, Sherman M, American Association for the Study of Liver Diseases (2011) Management of hepatocellular carcinoma: an update. Hepatology 53:1020–1022CrossRefPubMedPubMedCentralGoogle Scholar
  5. 5.
    Liver Imaging Reporting and Data System. www.acr.org. https://www.acr.org/Quality-Safety/Resources/LIRADS. Accessed 9 Aug 2017.
  6. 6.
    Cruite I, Tang A, Sirlin CB (2013) Imaging-based diagnostic systems for hepatocellular carcinoma. Am J Roentgenol 201:41–55CrossRefGoogle Scholar
  7. 7.
    Rofsky NM, Lee VS, Laub G, et al. (1999) Abdominal MR imaging with a volumetric interpolated breath-hold examination. Radiology. 212:876–884CrossRefPubMedGoogle Scholar
  8. 8.
    Pietryga JA, Burke LMB, Marin D, Jaffe TA, Bashir MR (2014) Respiratory motion artifact affecting hepatic arterial phase imaging with gadoxetate disodium: examination recovery with a multiple arterial phase acquisition. Radiology 271:426–434CrossRefPubMedGoogle Scholar
  9. 9.
    Rosset A, Spadola L, Ratib O (2004) OsiriX: an open-source software for navigating in multidimensional DICOM images. J Digit Imaging 17:205–216CrossRefPubMedPubMedCentralGoogle Scholar
  10. 10.
    Landis JR, Koch GG (1977) An application of hierarchical kappa-type statistics in the assessment of majority agreement among multiple observers. Biometrics 33:363–374CrossRefPubMedGoogle Scholar
  11. 11.
    Lee YJ, Lee JM, Lee JS, et al. (2015) Hepatocellular carcinoma: diagnostic performance of multidetector CT and MR imaging-a systematic review and meta-analysis. Radiology. 275:97–109CrossRefPubMedGoogle Scholar
  12. 12.
    Ikram NS, Yee J, Weinstein S, et al. (2017) Multiple arterial phase MRI of arterial hypervascular hepatic lesions: improved arterial phase capture and lesion enhancement. Abdom Radiol 42:870–876CrossRefGoogle Scholar
  13. 13.
    Kee K-M, Lu S-N (2017) Diagnostic efficacy of ultrasound in hepatocellular carcinoma diagnosis. Expert Rev Gastroenterol Hepatol 11:277–279CrossRefPubMedGoogle Scholar
  14. 14.
    Ehman EC, Behr SC, Umetsu SE, et al. (2016) Rate of observation and inter-observer agreement for LI-RADS major features at CT and MRI in 184 pathology proven hepatocellular carcinomas. Abdom Radiol 41:963–969CrossRefGoogle Scholar
  15. 15.
    Davenport MS, Khalatbari S, Liu PSC, et al. (2014) Repeatability of diagnostic features and scoring systems for hepatocellular carcinoma by using MR imaging. Radiology 272:132–142CrossRefPubMedPubMedCentralGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC 2017

Authors and Affiliations

  • Jennifer Y. Lee
    • 1
  • Eugene J. Huo
    • 1
  • Stefanie Weinstein
    • 1
    • 4
  • Charmaine Santos
    • 4
  • Alexander Monto
    • 2
    • 5
  • Carlos U. Corvera
    • 3
  • Judy Yee
    • 1
    • 4
  • Thomas A. Hope
    • 1
    • 4
  1. 1.Department of Radiology and Biomedical ImagingUniversity of California, San FranciscoSan FranciscoUSA
  2. 2.Department of GastroenterologyUniversity of California, San FranciscoSan FranciscoUSA
  3. 3.Department of SurgeryUniversity of California, San FranciscoSan FranciscoUSA
  4. 4.Department of RadiologyVeterans Affairs Medical CenterSan FranciscoUSA
  5. 5.Department of MedicineVeterans Affairs Medical CenterSan FranciscoUSA

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