Abbreviated MRI with second shot arterial phase for HCC evaluation: modified version of LI-RADS and recall reduction
Jeong Woo Kim1, Chang Hee Lee2, Kyeong Ah Kim1
1Department of Radiology, Korea University Guro Hospital, Korea University College of Medicine, 148 Gurodong-ro, Guro-gu, Seoul, 08380, Korea.
Objectives:
To evaluate the feasibility of simulated abbreviated MRI (AMRI) with second shot arterial phase (SSAP) for HCC surveillance and diagnosis.
Methods:
A total of 129 consecutive patients (age, 58.8 ± 11.4 years; male, 71.3%) underwent gadoxetic acid-enhanced MRI using a modified injection protocol for HCC evaluation from July 2017 to February 2018. The modified injection protocol consisted of routine dynamic imaging (6 mL) and SSAP imaging (4 mL). Two radiologists independently reviewed two AMRI sets: AMRI without SSAP (surveillance set) and AMRI with SSAP (diagnosis set). A modified version of the Liver Imaging Reporting and Data System (LI-RADS) for the diagnosis set was devised by referring to contrast-enhanced ultrasound LI-RADS.
Results:
Sixty-seven patients with HCC and 62 patients without HCC were included. In the surveillance set, sensitivity and specificity for the detection of patients with HCC were 95.5% and 96.8%, and 94.0% and 96.8% in reviewers 1 and 2, respectively. In the diagnosis set, the scores of most HCCs (76/78, 97.4%) were consistent between LI-RADS of full-protocol and modified LI-RADS of AMRI with SSAP protocol. When the HCC surveillance and diagnosis strategy was changed from strategy 1 (AMRI without SSAP) to strategy 2 (AMRI with SSAP), the recall rate significantly decreased from 52.7 to 3.9% (p < 0.001).
Conclusions:
The modified LI-RADS score of the AMRI with SSAP protocol showed high agreement with the LI-RADS score of the full protocol. The HCC surveillance and diagnosis strategy using the AMRI with SSAP protocol reduced the recall rate. These results may enable to diagnose HCC simultaneously with surveillance.
Key Points:
• A modified version of LI-RADS was devised for the diagnostic algorithm using AMRI with the second shot arterial phase (SSAP) by referring to CEUS LI-RADS. • The modified LI-RADS scores using AMRI with SSAP showed a high concordance rate with the conventional LI-RADS score using full-protocol MRI. • The recall rate significantly decreased when the HCC surveillance and diagnosis strategy was changed from strategy 1 (AMRI without SSAP; surveillance then recall test) to strategy 2 (AMRI with SSAP; simultaneous surveillance and diagnosis).
Insights
Abbreviated MRI with a second shot arterial phase (SSAP) offers a feasible approach for simultaneous hepatocellular carcinoma (HCC) surveillance and diagnosis. This strategy significantly reduces recall rates, improving efficiency in HCC management.
Area of Science:
- Hepatobiliary imaging
- Oncology imaging
- Radiology
Background:
- Hepatocellular carcinoma (HCC) surveillance requires efficient imaging protocols.
- Abbreviated MRI (AMRI) offers a time-efficient alternative to full-protocol MRI.
- Integrating diagnostic capabilities into surveillance protocols is desirable.
Purpose of the Study:
- To evaluate the feasibility of simulated abbreviated MRI (AMRI) with second shot arterial phase (SSAP) for HCC surveillance and diagnosis.
- To assess the performance of a modified LI-RADS algorithm for AMRI with SSAP.
- To compare the recall rates between AMRI without SSAP and AMRI with SSAP.
Main Methods:
- 129 patients underwent gadoxetic acid-enhanced MRI with a modified protocol including routine dynamic imaging and SSAP.
- Two radiologists independently reviewed AMRI sets: without SSAP (surveillance) and with SSAP (diagnosis).
- A modified LI-RADS was devised for the diagnosis set, referencing CEUS LI-RADS.
Main Results:
- Sensitivity and specificity for HCC detection in the surveillance set were high (95.5-96.8%).
- Modified LI-RADS scores for AMRI with SSAP showed high agreement (97.4%) with full-protocol LI-RADS.
- The recall rate significantly decreased from 52.7% to 3.9% (p < 0.001) with the SSAP strategy.
Conclusions:
- AMRI with SSAP is feasible for simultaneous HCC surveillance and diagnosis.
- The modified LI-RADS for AMRI with SSAP demonstrates high concordance with full-protocol MRI.
- This strategy effectively reduces recall rates, potentially streamlining HCC management.
