HCC screening: assessment of an abbreviated non-contrast MRI protocol.,European Radiology Experimental

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HCC screening: assessment of an abbreviated non-contrast MRI protocol.
European Radiology Experimental ( IF 3.7 ) Pub Date : 2019-12-18 , DOI: 10.1186/s41747-019-0126-1
Michael Vinchill Chan _{1,

2} , Stephen J McDonald ₁ , Yang-Yi Ong ₁ , Katerina Mastrocostas ₁ , Edwin Ho ₁ , Ya Ruth Huo ₃ , Cositha Santhakumar ₄ , Alice Unah Lee ₄ , Jessica Yang _{1,

2}

Affiliation

Background

Hepatocellular carcinoma (HCC) guidelines recommend ultrasound screening in high-risk patients. However, in some patients, ultrasound image quality is suboptimal due to factors such as hepatic steatosis, cirrhosis, and confounding lesions. Our aim was to investigate an abbreviated non-contrast magnetic resonance imaging (aNC-MRI) protocol as a potential alternative screening method.

Methods

A retrospective study was performed using consecutive liver MRI studies performed over 3 years, with set exclusion criteria. The unenhanced T2-weighted, T1-weighted Dixon, and diffusion-weighted sequences were extracted from MRI studies with a known diagnosis. Each anonymised aNC-MRI study was read by three radiologists who stratified each study into either return to 6 monthly screening or investigate with a full contrast-enhanced MRI study.

Results

A total of 188 patients were assessed; 28 of them had 42 malignant lesions, classified as Liver Imaging Reporting and Data System 4, 5, or M. On a per-patient basis, aNC-MRI had a negative predictive value (NPV) of 97% (95% confidence interval [CI] 95–98%), not significantly different in patients with steatosis (99%, 95% CI 93–100%) and no steatosis (97%, 95% CI 94–98%). Per-patient sensitivity and specificity were 85% (95% CI 75–91%) and 93% (95% CI 90–95%).

Conclusion

Our aNC-MRI HCC screening protocol demonstrated high specificity (93%) and NPV (97%), with a sensitivity (85%) comparable to that of ultrasound and gadoxetic acid contrast-enhanced MRI. This screening method was robust to hepatic steatosis and may be considered an alternative in the case of suboptimal ultrasound image quality.

中文翻译：

HCC 筛查：对简化的非对比 MRI 方案进行评估。

背景

肝细胞癌 (HCC) 指南建议对高危患者进行超声筛查。然而，在一些患者中，由于肝脂肪变性、肝硬化和混杂病变等因素，超声图像质量并不理想。我们的目的是研究一种简化的非对比磁共振成像 (aNC-MRI) 方案作为潜在的替代筛查方法。

方法

使用 3 年多的连续肝脏 MRI 研究进行回顾性研究，并设定排除标准。未增强的 T2 加权、T1 加权 Dixon 和扩散加权序列是从具有已知诊断的 MRI 研究中提取的。每项匿名 aNC-MRI 研究均由三名放射科医生阅读，他们将每项研究分层为返回 6 个月筛查或通过全面对比增强 MRI 研究进行调查。

结果

总共对 188 名患者进行了评估；其中 28 例有 42 个恶性病变，分类为肝脏成像报告和数据系统 4、5 或 M。以每个患者为基础，aNC-MRI 的阴性预测值 (NPV) 为 97%（95% 置信区间 [ CI] 95–98%），在脂肪变性患者（99%，95% CI 93–100%）和无脂肪变性患者（97%，95% CI 94–98%）之间没有显着差异。每个患者的敏感性和特异性分别为 85% (95% CI 75–91%) 和 93% (95% CI 90–95%)。