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Abbreviated MRI with optional multiphasic CT as an alternative to full-sequence MRI: LI-RADS validation in a HCC-screening cohort

  • Gastrointestinal
  • Published:
European Radiology Aims and scope Submit manuscript

Abstract

Objective

To compare the diagnostic performance of abbreviated MRI (AMRI) combined with multiphasic CT (mCT) with that of full-sequence gadoxetic acid-enhanced MRI (EOB-MRI) in a hepatocellular carcinoma (HCC)-screening cohort

Methods

Consecutive patients at risk of HCC who underwent EOB-MRI and mCT within 3 months for evaluation of new 0.5–3-cm hepatic observations were retrospectively recruited from 3 centers. An AMRI protocol comprising hepatobiliary phase, T2- and diffusion-weighted imaging, and dual-echo sequence was reconstituted from EOB-MRI. Two radiologists independently reviewed each observation in AMRI plus mCT (set 1) and EOB-MRI (set 2) per LI-RADS v2018. Per-lesion sensitivity, accuracy, and positive predictive value (PPV) for HCC were calculated and compared between image sets.

Results

In 267 patients, 306 histologically confirmed observations (280 HCCs, 20 combined hepatocellular-cholangiocarcinomas, 1 cholangiocarcinoma, and 5 benignities) were assessed. Set 1 yielded higher sensitivity (96.4% vs. 92.9%, p = 0.013) and comparable accuracy (91.2% vs. 87.6%) and PPV (94.1% vs. 93.5%) to set 2 using LI-RADS category (LR)-4/5 criteria. The sets showed comparable sensitivity (66.4% vs. 70.4%), accuracy (67.7% vs. 70.6%), and PPV (97.4% vs. 96.6%) using LR-5 criteria. A similar substantial number of non-HCC malignancies were categorized as LR-4 or LR-5, as was the number of HCCs categorized as LR-M in both sets.

Conclusions

AMRI combined with mCT showed diagnostic performance similar or superior to that of EOB-MRI for HCC diagnosis using LI-RADS. Therefore, mCT holds potential as a sequential examination for HCC diagnosis in AMRI-detected hepatic observation in patients at risk of HCC.

Key Points

• AMRI plus multiphasic CT showed comparable accuracy (91.2%) and PPV (94.1%) to full-sequence gadoxetic acid-enhanced MRI using LR-4/5 criteria.

• AMRI plus multiphasic CT was significantly more sensitive than full-sequence gadoxetic acid-enhanced MRI (96.4% vs. 92.9%) using LR-4/5 criteria.

• Multiphasic CT is a potential sequential modality for HCC diagnosis after AMRI.

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Abbreviations

AMRI:

Abbreviated magnetic resonance imaging

CC:

Cholangiocarcinoma

cHCC-CC:

Combined hepatocellular-cholangiocarcinoma

DN:

Dysplastic nodule

Dual-GRE:

T1-weighted in-phase and out-of-phase images

DWI:

Diffusion-weighted images

EOB-MRI:

Full-sequence gadoxetic acid-enhanced MRI

FN:

False negative

FP:

False positive

HBP:

T1-weighted hepatobiliary phase

HCC:

Hepatocellular carcinoma

LI-RADS:

Liver Imaging Reporting and Data System

LR:

LI-RADS category

mCT:

Multiphasic computed tomography

MRI:

Magnetic resonance imaging

PPV:

Positive predictive value

T2WI:

T2-weighted images

TN:

True negative

TP:

True positive

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Funding

This study was supported by a research fund from the Korean Society of Radiology through Radiology Imaging Network of Korea for Clinical Research (RINK-CR) and the Scientific Research Fund of the Korean Liver Cancer Study Group.

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Authors and Affiliations

  1. Department of Radiology, Gil Medical Center, Gachon University College of Medicine, Incheon, South Korea

    So Hyun Park & Young Sup Shim

  2. Department of Radiology, Ajou University School of Medicine, Ajou University Hospital, 164 World-cup ro, Yeongtong-gu, Suwon, 16499, South Korea

    Bohyun Kim, Jimi Huh & Hye Jin Kim

  3. Division of Abdominal Radiology, Department of Radiology and Research Institute of Radiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea

    So Yeon Kim, Kyung Won Kim & Seung Soo Lee

  4. Department of Internal Medicine, Gil Medical Center, Gachon University College of Medicine, Incheon, South Korea

    Ju Hyun Kim

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  1. So Hyun Park
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Correspondence to Bohyun Kim.

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Guarantor

The scientific guarantor of this publication is Bohyun Kim.

Conflict of interest

The authors declare that they have no conflicts of interest.

Statistics and biometry

Bohyun Kim, MD, PhD, who is one of the authors, has significant statistical expertise.

Informed consent

The requirement for written informed consent was waived for this study because this retrospective study was approved by the institutional review board of three institutions.

Ethical approval

Institutional review board approval of Asan Medical Center, Gil Medical Center, and Ajou University Hospital was obtained.

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• retrospective

• diagnostic or prognostic study

• multicenter study

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Park, S.H., Kim, B., Kim, S.Y. et al. Abbreviated MRI with optional multiphasic CT as an alternative to full-sequence MRI: LI-RADS validation in a HCC-screening cohort. Eur Radiol 30, 2302–2311 (2020). https://doi.org/10.1007/s00330-019-06546-5

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