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Gadolinium-enhanced MRI for tumor surveillance before liver transplantation: center-based experience
Thomas C Lauenstein1, Khalil Salman, Roger Morreira
1Department of Radiology, Emory University Hospital, Emory Clinic, Bldg. A, Ste. AT-627, 1365 Clifton Rd., Atlanta, GA 30322, USA.
Objective:
The purpose of this study was to evaluate prospectively acquired institutional results to determine the accuracy of gadolinium-enhanced MRI in liver tumor surveillance before transplantation.
Subjects And Methods:
One hundred fifteen patients underwent MRI of the abdomen within 90 days before liver transplantation. Images were acquired with gadolinium-enhanced 3D gradient-echo sequences in the arterial, venous, and delayed phases. Detection of hepatocellular carcinoma (HCC) was based on the imaging criteria arterial phase enhancement, delayed phase hypointensity, and development of an enhancing outer margin capsule. Imaging findings were compared with findings at histopathologic evaluation of the explanted liver.
Results:
Thirty-six HCCs in 27 patients were detected at histopathologic evaluation. Patient-based analysis showed the sensitivity of MRI was 88.9% (24/27); specificity, 97.7% (false-positive findings in two patients); and accuracy, 95.7%. MRI depicted 28 of 36 HCCs, resulting in a lesion-based sensitivity of 77.8%. Although all 18 HCCs 2 cm or larger were depicted with MRI, only 10 of 18 HCCs smaller than 2 cm were correctly diagnosed. However, two HCCs measuring smaller than 2 cm at pathologic examination were rated as dysplastic nodules on MRI.
Conclusion:
Contrast-enhanced MRI can be used as a primary diagnostic method for accurate detection and characterization of HCC 2 cm or larger as required by the criteria of the Model for End-Stage Liver Disease used by the United Network for Organ Sharing. MRI can be considered a standard tool for surveillance before liver transplantation. Reduction in cost and risk may be derived from the diminished need for other diagnostic imaging studies and biopsy and the avoidance of use of iodinated contrast agents in imaging of patients with cirrhosis, many of whom have impaired renal function.
Insights
Gadolinium-enhanced MRI accurately detects liver tumors, especially larger hepatocellular carcinomas (HCCs), for pre-transplant surveillance. This imaging method is a reliable tool for liver transplant candidates.
Area of Science:
- Radiology
- Hepatology
- Transplant Surgery
Background:
- Liver transplantation is a critical treatment for end-stage liver disease.
- Accurate surveillance for hepatocellular carcinoma (HCC) is essential for transplant eligibility and management.
- Gadolinium-enhanced magnetic resonance imaging (MRI) is a key imaging modality in liver disease assessment.
Purpose of the Study:
- To prospectively evaluate the accuracy of gadolinium-enhanced MRI for liver tumor surveillance before liver transplantation.
- To determine the diagnostic performance of MRI in detecting and characterizing hepatocellular carcinoma (HCC) in patients awaiting liver transplants.
Main Methods:
- One hundred fifteen patients underwent abdominal MRI within 90 days before liver transplantation.
- Gadolinium-enhanced 3D gradient-echo sequences were used, capturing arterial, venous, and delayed phases.
- HCC detection relied on specific imaging criteria; findings were compared with explanted liver histopathology.
Main Results:
- MRI demonstrated high patient-based accuracy (95.7%), sensitivity (88.9%), and specificity (97.7%) in detecting HCC.
- All 18 HCCs measuring 2 cm or larger were accurately depicted.
- MRI correctly identified 10 of 18 HCCs smaller than 2 cm, with two smaller HCCs misclassified as dysplastic nodules.
Conclusions:
- Contrast-enhanced MRI is a reliable primary diagnostic tool for detecting HCC ≥ 2 cm, meeting Model for End-Stage Liver Disease criteria.
- MRI serves as a standard surveillance tool for patients before liver transplantation.
- Utilizing MRI can potentially reduce costs and risks by minimizing the need for additional imaging and biopsies, especially in patients with cirrhosis and renal impairment.
