Abstract
Objectives
The primary objective was to compare the performance of 3 different abbreviated MRI (AMRI) sets extracted from a complete gadoxetate-enhanced MRI obtained for hepatocellular carcinoma (HCC) screening. Secondary objective was to perform a preliminary cost-effectiveness analysis, comparing each AMRI set to published ultrasound performance for HCC screening in the USA.
Methods
This retrospective study included 237 consecutive patients (M/F, 146/91; mean age, 58 years) with chronic liver disease who underwent a complete gadoxetate-enhanced MRI for HCC screening in 2017 in a single institution. Two radiologists independently reviewed 3 AMRI sets extracted from the complete exam: non-contrast (NC-AMRI: T2-weighted imaging (T2wi)+diffusion-weighted imaging (DWI)), dynamic-AMRI (Dyn-AMRI: T2wi+DWI+dynamic T1wi), and hepatobiliary phase AMRI (HBP-AMRI: T2wi+DWI+T1wi during the HBP). Each patient was classified as HCC-positive/HCC-negative based on the reference standard, which consisted in all available patient data. Diagnostic performance for HCC detection was compared between sets. Estimated set characteristics, including historical ultrasound data, were incorporated into a microsimulation model for cost-effectiveness analysis.
Results
The reference standard identified 13/237 patients with HCC (prevalence, 5.5%; mean size, 33.7 ± 30 mm). Pooled sensitivities were 61.5% for NC-AMRI (95% confidence intervals, 34.4–83%), 84.6% for Dyn-AMRI (60.8–95.1%), and 80.8% for HBP-AMRI (53.6–93.9%), without difference between sets (p range, 0.06–0.16). Pooled specificities were 95.5% (92.4–97.4%), 99.8% (98.4–100%), and 94.9% (91.6–96.9%), respectively, with a significant difference between Dyn-AMRI and the other sets (p < 0.01). All AMRI methods were effective compared with ultrasound, with life-year gain of 3–12 months against incremental costs of US$ < 12,000.
Conclusions
NC-AMRI has limited sensitivity for HCC detection, while HBP-AMRI and Dyn-AMRI showed excellent sensitivity and specificity, the latter being slightly higher for Dyn-AMRI. Cost-effectiveness estimates showed that AMRI is effective compared with ultrasound.
Key Points
• Comparison of different abbreviated MRI (AMRI) sets reconstructed from a complete gadoxetate MRI demonstrated that non-contrast AMRI has low sensitivity (61.5%) compared with contrast-enhanced AMRI (80.8% for hepatobiliary phase AMRI and 84.6% for dynamic AMRI), with all sets having high specificity.
• Non-contrast and hepatobiliary phase AMRI can be performed in less than 14 min (including set-up time), while dynamic AMRI can be performed in less than 17 min.
• All AMRI sets were cost-effective for HCC screening in at-risk population in comparison with ultrasound.
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Abbreviations
- AMRI:
-
Abbreviated magnetic resonance imaging
- DWI:
-
Diffusion-weighted imaging
- Dyn-AMRI:
-
Dynamic AMRI
- HBP:
-
Hepatobiliary phase
- HCC:
-
Hepatocellular carcinoma
- LI-RADS:
-
Liver Imaging Reporting and Data System
- NC-AMRI:
-
Non-contrast AMRI
- SS EPI:
-
Single-shot echo-planar imaging
- SS FSE:
-
Single-shot fast spin echo-planar imaging
- Wi:
-
Weighted imaging
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Funding
Naik Vietti Violi: Swiss National Science Foundation, fellowship P2LAP3_178053. The authors state no other funding for this work.
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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:
Claude B. Sirlin:
Industry research support: Bayer Healthcare, GE, Gilead, Philips, Siemens.
Consulting: Epigenomics
Institutional Consulting Representative: IBM-Watson
Mustafa R. Bashir:
Research grants: Siemens, NGM Biopharmaceuticals, Madrigal Pharmaceuticals, Metacrine Inc., ProSciento, Pinnacle Clinical Research, CymaBay Therapeutics
Consulting: MedPace
Kathryn J. Fowler:
Research grants: Bayer Healthcare, GE, Pfizer
Consulting: Epigenomics, 12 sigma, Medscape, Bayer Healthcare
Bachir Taouli:
Research grants: Bayer Healthcare, Takeda
Consultant: Bayer Healthcare, Alexion
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.
Statistics and biometry
One of the authors has significant statistical expertise. It is JS Babb.
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• retrospective
• case-control study
• performed at one institution
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Vietti Violi, N., Lewis, S., Liao, J. et al. Gadoxetate-enhanced abbreviated MRI is highly accurate for hepatocellular carcinoma screening. Eur Radiol 30, 6003–6013 (2020). https://doi.org/10.1007/s00330-020-07014-1
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DOI: https://doi.org/10.1007/s00330-020-07014-1