Comparison of noncontrast, dynamic, and hepatobiliary phase abbreviated MRI protocols for detection of hepatic...

Abbreviated MRI for surveillance in patients at risk for hepatocellular carcinoma (HCC) has recently gained interest.

To compare the performance among the three types of abbreviated MRI protocols for the detection of hepatic malignancies in patients at risk for HCC.

This retrospective review using data from a prospective-registry study included 221 patients with one or more hepatic nodules detected during surveillance for chronic liver disease. Patients underwent MRI with extracellular contrast agents (ECA-MRI) and MRI with hepatobiliary agents (HBA-MRI) before surgery. Sequences from each MRI were extracted to create three simulated abbreviated MRI (aMRI) sets: noncontrast aMRI (NC-aMRI), dynamic aMRI (Dyn-aMRI), and hepatobiliary phase aMRI (HBP-aMRI). Two readers evaluated each set and reported the probability of malignancy and possibility of non-HCC malignancy per lesion. Using the pathology report as reference, the diagnostic performance of each aMRI was compared.

This study included 289 observations (219 HCCs, 22 non-HCC malignancies, and 48 benign lesions). Defining category definite malignancy as test positive, the performance of each aMRI was as follows: sensitivity, 94.6%, 88.8%, and 92.5%; and specificity, 83.3%, 91.7%, and 85.4% for HBP-aMRI, Dyn-aMRI, and NC-aMRI, respectively. Pairwise comparison revealed higher sensitivity of HBP-aMRI than both Dyn-aMRI (P = 0.003) and NC-aMRI (P = 0.025), and higher specificity of Dyn-aMRI than HBP-aMRI (P = 0.046).

HBP-aMRI showed better sensitivity than Dyn-aMRI or NC-aMRI, whereas the sensitivity of NC-aMRI was comparable to Dyn-aMRI in the detection of malignancy in high-risk patients. Dyn-aMRI showed better specificity than HBP-aMRI.