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Abdom Radiol (NY). 2017 Jan;42(1):179-190. doi: 10.1007/s00261-016-0841-5.

Hepatocellular carcinoma detection: diagnostic performance of a simulated abbreviated MRI protocol combining diffusion-weighted and T1-weighted imaging at the delayed phase post gadoxetic acid.

Author information

1
Translational and Molecular Imaging Institute, Icahn School of Medicine at Mount Sinai, 1470 Madison Avenue, New York, NY, 10029, USA.
2
Department of Radiology, Icahn School of Medicine at Mount Sinai, New York, NY, 10029, USA.
3
Institute for Technology Assessment, Department of Radiology, Massachusetts General Hospital, Boston, MA, USA.
4
Department of Radiology, New York University Langone Medical Center, New York, NY, USA.
5
Division of Cancer Prevention and Control, Department of Oncological Sciences, Icahn School of Medicine at Mount Sinai, New York, NY, USA.
6
Department of Population Health Science and Policy, Icahn School of Medicine at Mount Sinai, New York, NY, USA.
7
Liver Imaging Group, Department of Radiology, University of California, San Diego, CA, USA.
8
Translational and Molecular Imaging Institute, Icahn School of Medicine at Mount Sinai, 1470 Madison Avenue, New York, NY, 10029, USA. bachir.taouli@mountsinai.org.
9
Department of Radiology, Icahn School of Medicine at Mount Sinai, New York, NY, 10029, USA. bachir.taouli@mountsinai.org.

Abstract

PURPOSE:

The purpose of this study was to evaluate the diagnostic performance of a "simulated" abbreviated MRI (AMRI) protocol using diffusion-weighted imaging (DWI) and T1-weighted (T1w) imaging obtained at the hepatobiliary phase (HBP) post gadoxetic acid injection alone and in combination, compared to dynamic contrast-enhanced (CE)-T1w imaging for the detection of hepatocellular carcinoma (HCC).

METHODS:

This was an IRB approved HIPAA compliant retrospective single institution study including patients with liver disease who underwent gadoxetic acid-enhanced MRI for HCC diagnosis. Three independent observers assessed 2 sets of images (full CE-set and AMRI including DWI+T1w-HBP). Diagnostic performance of T1w-HBP and DWI alone and in combination was compared to that of CE-set. All imaging sets included unenhanced T1w and T2w sequences. A preliminary analysis was performed to assess cost savings of AMRI protocol compared to a full MRI study.

RESULTS:

174 patients including 62 with 80 HCCs were assessed. Equivalent per-patient sensitivity and negative predictive value (NPV) were observed for DWI (85.5% and 92.2%, pooled data) and T1w-HBP (89.8% and 94.2%) (P = 0.1-0.7), while these were significantly lower for the full AMRI protocol (DWI+T1w-HBP, 80.6% and 80%, P = 0.02) when compared to CE-set (90.3% and 94.9%). Higher specificity and positive predictive value were observed for CE-set vs. AMRI (P = 0.02). The estimated cost reduction of AMRI versus full MRI ranged between 30.7 and 49.0%.

CONCLUSION:

AMRI using DWI and T1w-HBP has a clinically acceptable sensitivity and NPV for HCC detection. This could serve as the basis for a future study assessing AMRI for HCC screening and surveillance.

KEYWORDS:

Diffusion-weighted imaging; Gadoxetic acid; Hepatocellular carcinoma; MRI

PMID:
27448609
DOI:
10.1007/s00261-016-0841-5
[Indexed for MEDLINE]

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