Journal Article

Hepatocellular carcinoma detection in liver cirrhosis: diagnostic performance of contrast-enhanced CT vs. MRI with extracellular contrast vs. gadoxetic acid

Sirlin, Claude B, Swan, Thung, Taouli Bachir, Chatterji Manjil, Besa Cecilia, Babb, James S, Vietti Violi Naik, Isabel, Fiel M, Song, Christopher, Lewis, Sara, Schwartz, Myron, Semaan Sahar

2020

Overview

ObjectivesTo evaluate the diagnostic performance of contrast-enhanced CT vs. MRI with extracellular contrast agents (EC-MRI) vs. MRI with gadoxetic acid (EOB-MRI) for HCC detection in patients with liver cirrhosis using liver explant as the reference. The additional value of hepatobiliary phase (HBP) post Gadoxetic acid was also assessed.MethodsTwo-hundred seventy-seven consecutive patients who underwent liver transplantation over a 9 year period and imaging within 90 days of were retrospectively included. Imaging consisted in CT (n = 100), EC-MRI (n = 77) and EOB-MRI (n = 100), the latter subdivided into dynamic EOB-MRI and full EOB-MRI (dynamic+HBP). Three radiologists retrospectively categorized lesions ≥ 1 cm using the LI-RADSv2017 algorithm. Dynamic EOB-MRI was re-evaluated with the addition of HBP. Results were correlated with explant pathology.ResultsPathology demonstrated 265 HCCs (mean size 2.1 ± 1.4 cm) in 177 patients. Per-patient sensitivities were 86.3% for CT, 89.5% for EC-MRI, 92.8% for dynamic EOB-MRI and 95.2% for full EOB-MRI (pooled reader data), with a significant difference between CT and dynamic/full EOB-MRI (p = 0.032/0.002), and between EC-MRI and full EOB-MRI (p = 0.047). Per-lesion sensitivities for CT, EC-MRI, dynamic EOB-MRI and full EOB-MRI were 59.5%,78.5%,69.7% and 76.8%, respectively, with a significant difference between MRI groups and CT (p-range:0.001–0.04), and no difference between EC-MRI and dynamic EOB-MRI (p = 0.949). For HCCs 1–1.9 cm, sensitivities were 34.4%, 64.6%, 57.3% and 67.3%, respectively, with all MRI groups significantly superior to CT (p ≤ 0.01) and full EOB-MRI superior to dynamic EOB-MRI (p = 0.002).ConclusionsEOB-MRI outperforms CT and EC-MRI for per-patient HCC detection sensitivity, and is equivalent to EC-MRI for per-lesion sensitivity. MRI methods outperform CT for detection of HCCs 1–1.9 cm.Key points• MRI is superior to CT for HCC detection in patients with liver cirrhosis.• EOB-MRI outperforms CT and MRI using extracellular contrast agents (EC-MRI) for per-patient HCC detection sensitivity, and is equivalent to EC-MRI for per-lesion sensitivity.• The addition of hepatobiliary phase images improves HCC detection when using gadoxetic acid.

• Publisher: Springer Nature B.V
• Subject: Acids / Algorithms / Cirrhosis / Computed tomography / Contrast agents / Diagnostic systems / Equivalence / Hepatocellular carcinoma / Image detection / Lesions / Liver / Liver cancer / Liver cirrhosis / Liver transplantation / Magnetic resonance imaging / Medical diagnosis / Medical imaging / Pathology / Patients / Performance evaluation / Sensitivity / Transplantation