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Performance of gadoxetic acid MRI and diffusion-weighted imaging for the diagnosis of early recurrence of hepatocellular carcinoma

  • Hepatobiliary-Pancreas
  • Published:
European Radiology Aims and scope Submit manuscript

Abstract

Objective

To determine the diagnostic accuracy and predictive value of gadoxetic acid liver MRI (Gd-EOB-DTPA MRI) alone or in combination with diffusion-weighted imaging (DWI) as a second-line tool for detecting early hepatocellular carcinoma (HCC) recurrence in cirrhotic patients with previous HCC treated with resection or ablation.

Methods

Between 2014 and 2017, we prospectively included 34 cirrhotic patients with complete response to resection and/or ablation of early HCC in whom a new focal lesion enhancing in the arterial phase without washout was detected during follow-up with EC-MRI. After signing the informed consent, all patients underwent DWI and Gd-EOB-DTPA MRI; two readers analyzed signal intensities on each phase of dynamic study and on DWI. The final diagnosis was established by histology or follow-up EC-MRI. We used cross-tabulation to calculate indices of diagnostic accuracy.

Results

We evaluated 34 patients (7 women; 73.5% with hepatitis C virus) with a total of 53 new arterial-phase-enhancing foci (median size, 10 [IQR 9–14] mm). The final diagnosis, reached by histopathology in 15 (35.7%) lesions and EC-MR follow-up in 27 (64.3%), was HCC in 42 (79.2%) and benign conditions in 11 (21.8%). Hepatobiliary-phase hypointensity on Gd-EOB-DTPA MRI plus hyperintensity on DWI yielded 54.8% sensitivity, 90.9% specificity, 95.8% positive predictive value, and 34.5% negative predictive value for diagnosing HCC recurrence.

Conclusion

Among potential indices, combining hypointensity on hepatobiliary-phase Gd-EOB-DTPA MRI and hyperintensity on DWI has the highest specificity and positive predictive value to optimally detect HCC recurrence prior to confident diagnosis by conventional imaging criteria on EC-MRI in cirrhotic liver.

Key Points

• In patients at risk of HCC recurrence, the use of gadoxetic acid liver MRI and DWI may improve the differentiation of unspecific new arterial-enhancing foci from early hypervascular HCC recurrence in patients with non-conclusive findings on extracellular liver MRI.

• Combined findings on hepatobiliary-phase gadoxetic acid–enhanced liver MRI and DWI had high specificity (90.9%) and positive predictive value (95.8%) for detecting early hypervascular HCC recurrence, but limited sensitivity.

• Combining hepatobiliary-phase hypointensity on gadoxetic acid MRI and hyperintensity on diffusion-weighted imaging allows early diagnosis of hypervascular hepatocellular carcinoma and may help select patients for salvage therapy.

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Abbreviations

AASLD:

American Association for the Study of Liver Diseases

DWI:

Diffusion-weighted imaging

EASL:

European Association for the Study of the Liver

EC-MRI:

Extracellular gadolinium-enhanced liver MRI

Gd-EOB-DTPA:

MRI using gadoxetic acid

HCC:

Hepatocellular carcinoma

HR:

Hazard ratio

IQR:

Interquartile range

MRI:

Magnetic resonance imaging

RR:

Relative risk

References

  1. Poon RT, Fan ST, Lo CM, Liu CL, Wong J (2002) Long-term survival and pattern of recurrence after resection of small hepatocellular carcinoma in patients with preserved liver function. Ann Surg 235:373–382

    Article  Google Scholar 

  2. Tabrizian P, Jibara G, Shrager B, Schwartz M, Roayaie S (2015) Recurrence of hepatocellular cancer after resection: patterns, treatments, and prognosis. Ann Surg 261:947–955

    Article  Google Scholar 

  3. Sala M, Llovet JM, Vilana R et al (2004) Initial response to percutaneous ablation predicts survival in patients with hepatocellular carcinoma. Hepatology 40:1352–1360

    Article  Google Scholar 

  4. European Association for the Study of the Liver (2018) EASL Clinical Practice Guidelines: Management of hepatocellular carcinoma. J Hepatol 69:182–236

    Article  Google Scholar 

  5. Marrero JA, Kulik LM, Sirlin CB et al (2018) Diagnosis, Staging, and Management of Hepatocellular Carcinoma: 2018 Practice Guidance by the American Association for the Study of Liver Diseases. Hepatology 68:723–750

    Article  Google Scholar 

  6. Forner A, Vilana R, Ayuso C et al (2008) Diagnosis of hepatic nodules 20 mm or smaller in cirrhosis: prospective validation of the noninvasive diagnostic criteria for hepatocellular carcinoma. Hepatology 47:97–104

    Article  Google Scholar 

  7. Sangiovanni A, Manini MA, Iavarone M et al (2010) The diagnostic and economic impact of contrast imaging techniques in the diagnosis of small hepatocellular carcinoma in cirrhosis. Gut 59:638–644

    Article  Google Scholar 

  8. Khalili K, Kim TK, Jang H-J et al (2011) Optimization of imaging diagnosis of 1-2 cm hepatocellular carcinoma: an analysis of diagnostic performance and resource utilization. J Hepatol 54:723–728

    Article  Google Scholar 

  9. Joo I, Lee JM, Lee DH, Jeon JH, Han JK, Choi BI (2015) Noninvasive diagnosis of hepatocellular carcinoma on gadoxetic acid-enhanced MRI: can hypointensity on the hepatobiliary phase be used as an alternative to washout? Eur Radiol 25:2859–2868

    Article  Google Scholar 

  10. Granito A, Galassi M, Piscaglia F et al (2013) Impact of gadoxetic acid (Gd-EOB-DTPA)-enhanced magnetic resonance on the noninvasive diagnosis of small hepatocellular carcinoma: a prospective study. Aliment Pharmacol Ther 37:355–363

    Article  CAS  Google Scholar 

  11. Haradome H, Unno T, Morisaka H et al (2017) Gadoxetic acid disodium-enhanced MR imaging of cholangiolocellular carcinoma of the liver: imaging characteristics and histopathological correlations. Eur Radiol 27:4461–4471

    Article  Google Scholar 

  12. Bruix J, Sherman M, Llovet JM et al (2001) Clinical management of hepatocellular carcinoma. Conclusions of the Barcelona-2000 EASL conference. European Association for the Study of the Liver. J Hepatol 35:421–430

    Article  CAS  Google Scholar 

  13. Tremosini S, Forner A, Boix L et al (2012) Prospective validation of an immunohistochemical panel (glypican 3, heat shock protein 70 and glutamine synthetase) in liver biopsies for diagnosis of very early hepatocellular carcinoma. Gut 61:1481–1487

    Article  Google Scholar 

  14. International Consensus Group for Hepatocellular Neoplasia The International Consensus Group for Hepatocellular Neoplasia (2009) Pathologic diagnosis of early hepatocellular carcinoma: A report of the International Consensus Group for Hepatocellular Neoplasia. Hepatology 49:658–664

    Article  Google Scholar 

  15. Rimola J, Forner A, Tremosini S et al (2012) Non-invasive diagnosis of hepatocellular carcinoma ≤ 2 cm in cirrhosis. Diagnostic accuracy assessing fat, capsule and signal intensity at dynamic MRI. J Hepatol 56:1317–1323

    Article  Google Scholar 

  16. Iavarone M, Sangiovanni A, Forzenigo LV et al (2010) Diagnosis of hepatocellular carcinoma in cirrhosis by dynamic contrast imaging: the importance of tumor cell differentiation. Hepatology 52:1723–1730

    Article  Google Scholar 

  17. Darnell A, Forner A, Rimola J et al (2015) Liver imaging reporting and data system with MR imaging: evaluation in nodules 20 mm or smaller detected in cirrhosis at screening US. Radiology 275:141–132

    Article  Google Scholar 

  18. Choi JW, Lee JM, Kim SJ et al (2013) Hepatocellular carcinoma: imaging patterns on gadoxetic acid–enhanced MR images and their value as an imaging biomarker. Radiology 267:776–786

    Article  Google Scholar 

  19. Sugimoto K, Kim SR, Imoto S et al (2015) Characteristics of hypovascular versus hypervascular well-differentiated hepatocellular carcinoma smaller than 2 cm - focus on tumor size, markers and imaging detectability. Dig Dis 33:721–727

    Article  Google Scholar 

  20. Yoon JH, Lee JM, Kang H et al (2019) Quantitative assessment of liver function by using gadoxetic acid–enhanced MRI: hepatocyte uptake ratio. Radiology 290:125–133

    Article  Google Scholar 

  21. Kim AY, Kim YK, Lee MW et al (2012) Detection of hepatocellular carcinoma in gadoxetic acid-enhanced MRI and diffusion-weighted MRI with respect to the severity of liver cirrhosis. Acta Radiol 53:830–838

  22. Nakamura Y, Tashiro H, Nambu J et al (2013) Detectability of hepatocellular carcinoma by gadoxetate disodium-enhanced hepatic MRI: tumor-by-tumor analysis in explant livers. J Magn Reson Imaging 37:684–691

    Article  Google Scholar 

  23. Motosugi U, Ichikawa T, Sou H et al (2010) Distinguishing hypervascular pseudolesions of the liver from hypervascular hepatocellular carcinomas with gadoxetic acid-enhanced MR imaging. Radiology 256:151–158

    Article  Google Scholar 

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Funding

This study has received funding by Sociedad Española de Radiología Médica (SERAM).

Author information

Authors and Affiliations

  1. BCLC group, Radiology Department, Hospital Clínic Barcelona, Barcelona, Spain

    Jordi Rimola, Anna Darnell, Angeles García-Criado, Lluís Bianchi, Ramon Vilana & Carmen Ayuso

  2. University of Barcelona, Barcelona, Spain

    Jordi Rimola, Alejandro Forner, Anna Darnell, Angeles García-Criado, Lluís Bianchi, Carmen Ayuso & Jordi Bruix

  3. BCLC group, Liver Unit, Hospital Clínic Barcelona, Barcelona, Spain

    Alejandro Forner, Neus Llarch, Álvaro Díaz-González, Jordi Bruix & María Reig

  4. IDIBAPS, Barcelona, Spain

    Alejandro Forner, Víctor Sapena, Carmen Ayuso, Jordi Bruix & María Reig

  5. BCLC group, Statistics core, Barcelona, Spain

    Víctor Sapena

  6. BCLC group, Pathology Department, Hospital Clínic Barcelona, Barcelona, Spain

    Alba Díaz

Authors
  1. Jordi Rimola
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  2. Alejandro Forner
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  3. Víctor Sapena
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  4. Neus Llarch
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  7. Angeles García-Criado
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  8. Lluís Bianchi
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  9. Ramon Vilana
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  10. Álvaro Díaz-González
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  11. Carmen Ayuso
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  12. Jordi Bruix
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  13. María Reig
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Corresponding author

Correspondence to Jordi Rimola.

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Guarantor

The scientific guarantor of this publication is Jordi Rimola.

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.

Statistics and biometry

Victor Sapena kindly provided statistical advice for this manuscript.

Informed consent

Written informed consent was obtained from all subjects (patients) in this study.

Ethical approval

Institutional Review Board approval was obtained.

Methodology

• prospective

• diagnostic or prognostic study

• performed at one institution

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Rimola, J., Forner, A., Sapena, V. et al. Performance of gadoxetic acid MRI and diffusion-weighted imaging for the diagnosis of early recurrence of hepatocellular carcinoma. Eur Radiol 30, 186–194 (2020). https://doi.org/10.1007/s00330-019-06351-0

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  • DOI: https://doi.org/10.1007/s00330-019-06351-0

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