Diagnostic accuracy of MRI with extracellular vs. hepatobiliary contrast material for detection of residual hepatocellular carcinoma after locoregional treatment
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To compare the diagnostic accuracy of extracellular gadolinium-based contrast-enhanced MRI (Gd-MRI) and gadoxetic acid-enhanced MRI (EOB-MRI) for the assessment of hepatocellular carcinoma (HCC) response to locoregional therapy (LRT) using explant correlation as the reference standard.
Forty-nine subjects with cirrhosis and HCC treated with LRT who underwent liver MRI using either Gd-MRI (n = 26) or EOB-MRI (n = 23) within 90 days of liver transplantation were included. Four radiologists reviewed the MR images blinded to histology to determine the size and percentage of viable residual HCC using a per-lesion explant reference standard. Sensitivities, specificities, accuracies, and agreement with histology for the detection residual HCC were calculated.
Gd-MRI had greater agreement with histology (ICC: 0.98 [0.95–0.99] vs. 0.80 [0.63–0.90]) and greater sensitivity for viable HCC (76% [13/17 50–93%] vs. 58% [7/12; 28–85%]) than EOB-MRI; specificities were similar (84% [16/19; 60–97%] vs. 85% [23/27; 66–96%]). Areas under ROC curves for detecting residual viable tumor were 0.80 (0.64–0.92) for Gd-MRI and 0.72 (0.55–0.85) for EOB-MRI. Gd-MRI had greater inter-rater agreement than EOB-MRI for determining the size of residual viable HCC (ICC: 0.96 [0.92–0.98] vs. 0.85 [0.72–0.92]).
Gd-MRI may be more accurate and precise than EOB-MRI for the assessment of viable HCC following LRT.
KeywordsHepatocellular carcinoma Liver Magnetic resonance imaging Radiofrequency ablation Trans-arterial chemoembolization
Gadolinium-based contrast-enhanced MRI
Gadoxetic acid-enhanced MRI
Receiver operator characteristics
European Association for the Study of the Liver
Compliance with ethical standards
Jordi Rimola was partially supported by a grant from Fundación Alfonso Martín Escudero.
Conflict of interest
The authors of this manuscript declare no relationships with any companies, whose products or services may be related to the subject matter of the article.
Institutional Review Board approval was obtained. Written informed consent was waived by the Institutional Review Board. This article does not contain any studies with animals performed by any of the authors.
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