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Gadoxetate-enhanced Abbreviated MRI for Hepatocellular Carcinoma Surveillance: Preliminary Experience
Ryan L Brunsing1, Dennis H Chen1, Alexandra Schlein1
1Liver Imaging Group, Department of Radiology, University of California San Diego, 200 W Arbor Dr, San Diego, CA 92103 (R.L.B., D.H.C., A.S., A.M., C.B.S.); Computational and Applied Statistics Laboratory, San Diego Supercomputer Center, University of California San Diego, San Diego, Calif (T.W., A.G.); Department of Radiology, Translational and Molecular Imaging Institute, Icahn School of Medicine at Mount Sinai, New York, NY (N.V.V., B.T.); Department of Radiology, Lausanne University Hospital, Lausanne, Switzerland (N.V.V.); Department of Radiology, Naval Medical Center San Diego, Uniformed Services University of the Health Sciences, Bethesda, Md (R.M.M.); Division of Epidemiology, Department of Family Medicine and Preventive Medicine, University of California San Diego, La Jolla, Calif (R.L.); NAFLD Research Center, Department of Medicine, University of California San Diego, La Jolla, Calif (R.L.); and Department of Medicine and Radiology, University of California San Diego, La Jolla, Calif (Y.K.).
Purpose:
To describe a single-center preliminary experience with gadoxetate disodium-enhanced abbreviated MRI for hepatocellular carcinoma (HCC) screening and surveillance in patients with cirrhosis or chronic hepatitis B virus (cHBV).
Materials And Methods:
This was a retrospective study of consecutive patients aged 18 years and older with cirrhosis or cHBV who underwent at least one gadoxetate-enhanced abbreviated MRI examination for HCC surveillance from 2014 through 2016. Examinations were interpreted prospectively by one of six abdominal radiologists for clinical care. Clinical, imaging, and other data were extracted from electronic medical records. Diagnostic adequacy was assessed in all patients. Diagnostic accuracy was assessed in the subset of patients who could be classified as having HCC or not having HCC on the basis of a composite reference standard.
Results:
In this study, 330 patients (93% with cirrhosis; 45% women; mean age, 59 years) underwent gadoxetate-enhanced abbreviated MRI. In the 330 patients, 311 (94.2%) baseline gadoxetate-enhanced abbreviated MRI examinations were diagnostically adequate. Of 141 (43%) of the 330 patients, 91.4% (129 of 141) could be classified as not having HCC and 8.6% (12 of 141) could be classified as having HCC. Baseline gadoxetate-enhanced abbreviated MRI had 0.92 sensitivity (95% confidence interval [CI]: 0.62, 1.00) and 0.91 specificity (95% CI: 0.84, 0.95) for detection of HCC. Of the 330 patients who underwent baseline gadoxetate-enhanced abbreviated MRI, 187 (57%) were lost to follow-up.
Conclusion:
Gadoxetate-enhanced abbreviated MRI is feasible clinically, has a high diagnostic adequacy rate, and, on the basis of our preliminary experience, accurately depicts HCC in high-risk patients. Strategies to enhance follow-up compliance are needed.© RSNA, 2019Keywords: Abdomen/GI, Cirrhosis, Liver, MR-Imaging, Oncology, ScreeningSupplemental material is available for this article.
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