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Extracellular contrast-enhanced MRI with diffusion-weighted imaging for HCC diagnosis: prospective comparison with gadoxetic acid using LI-RADS

  • Hepatobiliary-Pancreas
  • Published:
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Abstract

Objectives

The aim of this study was to evaluate the diagnostic performance of introducing diffusion-weighted imaging (DWI) as a major feature to extracellular agent (ECA)-MRI for diagnosing HCC in comparison with gadoxetic acid (hepatobiliary agent, HBA)-MRI using Liver Imaging Reporting and Data System (LI-RADS) v2018.

Methods

This was a prospective intra-individual comparison study using two different types of contrast agents for liver MRI conducted at a tertiary referral academic center. One hundred forty-seven observations in 122 patients at high risk for HCC scheduled for liver surgery were included. The sensitivity, specificity, and accuracy of LI-RADS category 5 (LR-5) for HCC diagnosis according to conventional and modified LI-RADS on ECA- and HBA-MRI were measured and compared. Modified LI-RADS incorporated hyperintensity on DWI as a major feature with ECA-MRI, and hypointensity on transitional phase (TP) and/or hepatobiliary phase (HBP) as washout appearance on HBA-MRI, respectively.

Results

Modified LI-RADS on ECA-MRI had higher sensitivity and accuracy than modified LI-RADS on HBA-MRI (90.3% vs. 74.9%, p < 0.001; and 91.9% vs. 76.9%, p < 0.001, respectively), as well as higher specificity, although the difference did not reach statistical significance (96.0% vs. 88.0%, p = 0.157). The specificity of modified LI-RADS ECA-MRI was slightly lower than both conventional criteria but without a significant difference (96.0% vs. 100%, p = 0.317).

Conclusions

Using DWI findings as a major feature for modified LR-5 on ECA-MRI showed better sensitivity and accuracy than modified LR-5 on HBA-MRI, without significantly compromising specificity compared with conventional LR-5 on ECA- or HBA-MRI.

Key Points

• Prospective intra-individual comparison study using two different types of contrast agents, extracellular agent (ECA) and gadoxetic acid (hepatobiliary agent, HBA), for liver MRI was conducted.

• Applying diffusion restriction of a hepatic observation on ECA-MRI as a major feature of LI-RADS v2018 resulted in higher sensitivity and accuracy of LR-5 observations for HCC diagnosis than conventional LI-RADS v2018, and even compared to modified LI-RADS using modified washout on HBA-MRI.

• Despite increase in sensitivity and accuracy of LR-5 observations on modified LI-RADS on ECA-MRI, the specificity was not significantly different compared with conventional LI-RADS.

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Abbreviations

AASLD:

American Association for the Study of Liver Disease

APHE:

Arterial phase hyperenhancement

APS:

Arterioportal shunt

CHC:

Combined hepatocellular-cholangiocarcinomas

CT:

Computed tomography

DN:

Dysplastic nodules

DP:

Delayed phase

DWI:

Diffusion-weighted imaging

EASL:

European Association for the Study of the Liver

ECA:

Extracellular agent

HBP:

Hepatobiliary phase

HBA:

Hepatobiliary agent

HCC:

Hepatocellular carcinoma

HH:

Hepatic hemangioma

ICC:

Intrahepatic cholangiocarcinoma

LI-RADS:

Liver Imaging Reporting and Data System

LR:

LI-RADS category

LT:

Liver transplantation

mLR:

Modified LI-RADS category

MRI:

Magnetic resonance imaging

NET:

Neuroendocrine tumor

NP:

Negative predictive value

PPV:

Positive predictive value

PVP:

Portal venous phase

TP:

Transitional phase

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Funding

The authors state that this work has not received any funding.

Author information

Author notes

  1. Dong Ik Cha and Gyu Seong Choi contributed equally as co-first authors to this work.

Authors and Affiliations

  1. Department of Radiology and Center for Imaging Science, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81 Irwon-ro Gangnam-gu, Seoul, 06351, Republic of Korea

    Dong Ik Cha, Young Kon Kim, Tae Wook Kang & Kyoung Doo Song

  2. Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea

    Gyu Seong Choi & Jong Man Kim

  3. Department of Mathematics, Ajou University, Suwon, Republic of Korea

    Soo Hyun Ahn

Authors
  1. Dong Ik Cha
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Corresponding author

Correspondence to Young Kon Kim.

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Guarantor

The scientific guarantor of this publication is Young Kon Kim.

Conflict of interest

The authors of this manuscript declare no relationships with any companies whose products or services may be related to the subject matter of the article.

Statistics and biometry

One of the authors has significant statistical expertise.

Informed consent

Written informed consent was obtained from all subjects (patients) in this study.

Ethical approval

Institutional Review Board approval was obtained.

Study subjects or cohorts overlap

Some study subjects or cohorts have been previously reported in a previous journal. The patient population of this study is part of a prospective-registry of patients scheduled for surgery gathered in our medical center, and includes partial data from a previous prospective study which included 91 patients (Hepatology 2018:68:2254-2256). This study differs from the previous one in that this study emphasizes on the value of diffusion restriction, an ancillary feature of LI-RADS, on ECA-MRI, whereas the previous one focuses on the value of modified (illusional) washout.

Methodology

• Prospective

• Diagnostic or prognostic study

• Performed at one institution

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Cha, D.I., Choi, G.S., Kim, Y.K. et al. Extracellular contrast-enhanced MRI with diffusion-weighted imaging for HCC diagnosis: prospective comparison with gadoxetic acid using LI-RADS. Eur Radiol 30, 3723–3734 (2020). https://doi.org/10.1007/s00330-020-06753-5

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  • DOI: https://doi.org/10.1007/s00330-020-06753-5

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