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Do transition and hepatobiliary phase hypointensity improve LI-RADS categorization as an alternative washout: a
Junhan Pan1, Yufeng Tao1, Xiaoping Chi1,2
1Department of Radiology, Zhejiang University School of Medicine First Affiliated Hospital, No.79 Qingchun Road, Hangzhou, 310003, China.
Objective:
The definition of washout in gadoxetate disodium-enhanced MRI (Gd-EOB-MRI) is controversial. The current Liver Imaging Reporting and Data System (LI-RADS) defines washout only in the portal venous phase on Gd-EOB-MRI, leading to low diagnostic sensitivity for HCC. We performed a meta-analysis to compare the diagnostic performance of Gd-EOB-MRI using conventional (cWO) and modified (mWO) definitions of washout.
Methods:
The PubMed and EMBASE databases were searched to identify studies published between January 1, 2010, and August 1, 2021, that compared the diagnostic performance of cWO and mWO for HCC. The mWOs added transition phase (TP) hypointensity (mWO-1), hepatobiliary phase (HBP) hypointensity (mWO-2), or both (mWO-3). The pooled sensitivity and specificity were calculated using a bivariate random-effects model. Study heterogeneity was explored by subgroup analysis and meta-regression analysis.
Results:
Ten comparative studies with 2391 patients were included. Compared to cWO, the overall mWO yielded significantly higher sensitivity (71% vs. 81%, p = 0.00) and lower specificity (97% vs. 93%, p = 0.01) for diagnosing HCC. The area under the curve (AUC) was 0.90 and 0.94 for the cWO and mWO, respectively. Regarding the three types of mWOs, mWO-2 showed the highest sensitivity (85%) and specificity (96%) for diagnosing HCC. mWO-2 achieved the highest AUC (0.97), followed by mWO-1 (0.90), and mWO-3 (0.89). Average reviewer experience and scanner field strength were significantly associated with study heterogeneity (p < 0.05).
Conclusions:
Inclusion of TP and HBP hypointensity in the definition of washout improved the sensitivity with slightly lower specificity for diagnosing HCC in LI-RADS.
Key Points:
• Compared to the conventional definition of washout, studies using a modified definition had higher sensitivity (71% vs. 81%) but lower specificity (97% vs. 93%) in LI-RADS for the diagnosis of HCC. • Hepatobiliary phase hypointensity may be a preferred alternative washout for HCC diagnosis with the highest area under the curve. • Studies with experienced reviewer or 3.0T MRI showed higher sensitivity and lower specificity for diagnosing HCC when using modified washout (p < 0.05).
Insights
Modified washout definitions in gadoxetate disodium-enhanced MRI significantly improve hepatocellular carcinoma (HCC) detection sensitivity. Incorporating hepatobiliary phase hypointensity offers the best diagnostic performance for HCC.
Area of Science:
- Radiology
- Oncology
- Medical Imaging
Background:
- The current Liver Imaging Reporting and Data System (LI-RADS) definition of washout in gadoxetate disodium-enhanced MRI (Gd-EOB-MRI) has low sensitivity for detecting hepatocellular carcinoma (HCC).
- This limitation stems from defining washout solely in the portal venous phase.
Purpose of the Study:
- To compare the diagnostic performance of conventional (cWO) and modified (mWO) washout definitions in Gd-EOB-MRI for HCC detection.
- To evaluate the impact of incorporating transition phase (TP) and hepatobiliary phase (HBP) hypointensity into washout definitions.
Main Methods:
- A meta-analysis of studies published between 2010 and 2021 comparing cWO and mWO for HCC diagnosis.
- Modified washout definitions included TP hypointensity (mWO-1), HBP hypointensity (mWO-2), or both (mWO-3).
- Bivariate random-effects modeling was used to calculate pooled sensitivity and specificity; heterogeneity was assessed via subgroup and meta-regression analyses.
Main Results:
- Ten studies with 2391 patients were analyzed.
- Modified washout (mWO) demonstrated significantly higher sensitivity (81% vs. 71%) and lower specificity (93% vs. 97%) compared to conventional washout (cWO) for HCC diagnosis.
- Hepatobiliary phase hypointensity (mWO-2) yielded the highest AUC (0.97), with superior sensitivity (85%) and specificity (96%) for HCC detection.
Conclusions:
- Including TP and HBP hypointensity in washout definitions enhances HCC diagnostic sensitivity in LI-RADS, albeit with a slight decrease in specificity.
- Hepatobiliary phase hypointensity is a promising alternative washout criterion for improved HCC diagnosis.
- Study factors like reviewer experience and 3.0T MRI scanners influenced diagnostic performance.
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