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Hepatocellular carcinoma detection in liver cirrhosis: diagnostic performance of contrast-enhanced CT vs. MRI with extracellular contrast vs. gadoxetic acid

  • Hepatobiliary-Pancreas
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Abstract

Objectives

To evaluate the diagnostic performance of contrast-enhanced CT vs. MRI with extracellular contrast agents (EC-MRI) vs. MRI with gadoxetic acid (EOB-MRI) for HCC detection in patients with liver cirrhosis using liver explant as the reference. The additional value of hepatobiliary phase (HBP) post Gadoxetic acid was also assessed.

Methods

Two-hundred seventy-seven consecutive patients who underwent liver transplantation over a 9 year period and imaging within 90 days of were retrospectively included. Imaging consisted in CT (n = 100), EC-MRI (n = 77) and EOB-MRI (n = 100), the latter subdivided into dynamic EOB-MRI and full EOB-MRI (dynamic+HBP). Three radiologists retrospectively categorized lesions ≥ 1 cm using the LI-RADSv2017 algorithm. Dynamic EOB-MRI was re-evaluated with the addition of HBP. Results were correlated with explant pathology.

Results

Pathology demonstrated 265 HCCs (mean size 2.1 ± 1.4 cm) in 177 patients. Per-patient sensitivities were 86.3% for CT, 89.5% for EC-MRI, 92.8% for dynamic EOB-MRI and 95.2% for full EOB-MRI (pooled reader data), with a significant difference between CT and dynamic/full EOB-MRI (p = 0.032/0.002), and between EC-MRI and full EOB-MRI (p = 0.047). Per-lesion sensitivities for CT, EC-MRI, dynamic EOB-MRI and full EOB-MRI were 59.5%,78.5%,69.7% and 76.8%, respectively, with a significant difference between MRI groups and CT (p-range:0.001–0.04), and no difference between EC-MRI and dynamic EOB-MRI (p = 0.949). For HCCs 1–1.9 cm, sensitivities were 34.4%, 64.6%, 57.3% and 67.3%, respectively, with all MRI groups significantly superior to CT (p ≤ 0.01) and full EOB-MRI superior to dynamic EOB-MRI (p = 0.002).

Conclusions

EOB-MRI outperforms CT and EC-MRI for per-patient HCC detection sensitivity, and is equivalent to EC-MRI for per-lesion sensitivity. MRI methods outperform CT for detection of HCCs 1–1.9 cm.

Key points

• MRI is superior to CT for HCC detection in patients with liver cirrhosis.

• EOB-MRI outperforms CT and MRI using extracellular contrast agents (EC-MRI) for per-patient HCC detection sensitivity, and is equivalent to EC-MRI for per-lesion sensitivity.

• The addition of hepatobiliary phase images improves HCC detection when using gadoxetic acid.

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Abbreviations

CT:

Computed tomography

DWI:

Diffusion-weighted imaging

EC-MRI:

Extracellular gadolinium based contrast-enhanced MRI

EOB-MRI:

Gadoxetic acid-enhanced MRI

FP:

False positive

GBCAs:

Gadolinium based contrast agents

HBP:

Hepatobiliary phase

LI-RADS:

Liver imaging reporting and data system

NPV:

Negative predictive value

PPV:

Positive predictive value

TN:

True negative

TP:

True positive

UNOS:

United network for organ sharing

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Funding

The authors state that this work has not received any funding.

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Authors and Affiliations

  1. Department of Radiology, Body MRI, Icahn School of Medicine at Mount Sinai, One Gustave L. Levy Place, 1470 Madison Avenue, New York, NY, 10029, USA

    Sahar Semaan, Sara Lewis, Manjil Chatterji, Christopher Song & Bachir Taouli

  2. Translational and Molecular Imaging Institute, Icahn School of Medicine at Mount Sinai, One Gustave L. Levy Place, 1470 Madison Avenue, New York, NY, 10029, USA

    Sahar Semaan, Naik Vietti Violi, Sara Lewis, Cecilia Besa & Bachir Taouli

  3. Department of Radiology, Lausanne University Hospital, Rue du Bugnon 46, 1011, Lausanne, Switzerland

    Naik Vietti Violi

  4. Department of Radiology, School of Medicine, Pontificia Universidad Católica de Chile, Avenida Libertador Bernardo O’Higgins 340, 8331150, Santiago, Chile

    Cecilia Besa

  5. Department of Radiology, New York University Langone Medical Center, 333 E 38th Street, New York, NY, 10016, USA

    James S. Babb

  6. Department of Pathology, Icahn School of Medicine at Mount Sinai, One Gustave L. Levy Place, New York, NY, 10029, USA

    M. Isabel Fiel & Swan Thung

  7. Recanati/Miller Transplantation Institute, Icahn School of Medicine at Mount Sinai, One Gustave L. Levy Place, New York, NY, USA

    Myron Schwartz

  8. Liver Imaging Group, Department of Radiology, UC San Diego Medical Center, 200 West Arbor Drive, San Diego, CA, USA

    Claude B. Sirlin

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  1. Sahar Semaan
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Correspondence to Bachir Taouli.

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The scientific guarantor of this publication is Bachir Taouli.

Conflict of interest

The authors of this manuscript declare relationships with the following companies:

Bachir Taouli: Grant, Bayer Healthcare.

The other authors of this manuscript declare no relationships with any companies, whose products or services may be related to the subject matter of the article.

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One of the authors (JS Babb) has significant statistical expertise.

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• case-control study.

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Sahar Semaan and Naik Vietti Violi are co-first authors.

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Semaan, S., Vietti Violi, N., Lewis, S. et al. Hepatocellular carcinoma detection in liver cirrhosis: diagnostic performance of contrast-enhanced CT vs. MRI with extracellular contrast vs. gadoxetic acid. Eur Radiol 30, 1020–1030 (2020). https://doi.org/10.1007/s00330-019-06458-4

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