Marion Roux1, Frederic Pigneur2, Laurence Baranes2,3, Julien Calderaro3,4, Mélanie Chiaradia2,3, Thomas Decaens3,5, Sandrine Kastahian6, Anaïs Charles-Nelson6, Lambros Tselikas2, Charlotte Costentin3,5, Alexis Laurent3,7, Daniel Azoulay3,7, Ariane Mallat3,5, Alain Rahmouni2,3, Alain Luciani2,3,8. 1. Service de Radiodiagnostic et Radiologie interventionnelle, CHUV, Rue du Bugnon 46, 1011, Lausanne, Switzerland. marionroux@gmail.com. 2. Groupe Henri Mondor Albert Chenevier, Imagerie Medicale, AP-HP, 94010, Creteil, France. 3. Faculte de Medecine de Creteil, Universite Paris Est Creteil, 94010, Creteil, France. 4. Groupe Henri Mondor Albert Chenevier, Pathology, AP-HP, 94010, Creteil, France. 5. Groupe Henri Mondor Albert Chenevier, Hepato-Gastroenterology Department, AP-HP, 94010, Creteil, France. 6. Groupe Henri Mondor Albert Chenevier, Unite de Recherche Clinique (URC), AP-HP, 94010, Creteil, France. 7. Groupe Henri Mondor Albert Chenevier, Liver Surgery, AP-HP, 94010, Creteil, France. 8. INSERM Unite U 955, Equipe 18, 94010, Creteil, France.
Abstract
PURPOSE: To assess the value of Hepatobiliary phase MRI (HPB-MRI) to differentiate FNH and HCA, and evaluate its impact on diagnostic accuracy, diagnostic confidence, inter-observer variability, and patient clinical management. METHODS: Forty-nine patients referred for Gd-BOPTA-enhanced MRI were retrospectively included in this IRB-approved study, with a total of 119 lesions-90 FNH and 29 HCA. Two observers separately assessed in 2 distinct randomized reading sessions the performance of MRI with (HBP-MRI) or without (conventional MRI) the use of HBP images. Each lesion was ranked with a 5-point scale (from 1 Typical FNH to 5 Certainly not a FNH). Sensitivity, specificity, overall accuracy, and inter-observer agreement for the differentiation of FNH from HCA were calculated and compared between conventional and HBP-MRI. RESULTS: Both sensitivity (respective values of 38.9% and 97.8%), overall accuracy (respective values of 53.8% and 98.3%), and inter-observer agreement (respective values of Kappa 0.56 and 0.88) were significantly higher using HBP-MRI than with conventional MRI, with unchanged specificity (100%). The sensitivity of conventional MRI for the diagnosis of FNH was significantly lower in lesions ≤ 3 cm (20% vs. 88%). Overall, HBP could have changed lesion management in 59/119 cases (49.5%), including 53 FNH and 6 HCA with no impact in 60/119 lesions (50.5%) including all 35 lesions classified as scores 1 and 2 for the diagnosis of FNH. CONCLUSIONS: The clinical impact of HBP-MRI is mostly important for smaller than 3-cm FNH, and more limited in larger FNH lesions as well as for HCA diagnosis for which conventional MRI is already accurate. The use of extracellular contrast agents upfront could limit the required use of linear HBP contrast agents for benign hepatocellular lesion characterization. On HBP, all FNH appeared hypointense compared to adjacent liver while close to 97% of HCA appeared hypointense.
PURPOSE: To assess the value of Hepatobiliary phase MRI (HPB-MRI) to differentiate FNH and HCA, and evaluate its impact on diagnostic accuracy, diagnostic confidence, inter-observer variability, and patient clinical management. METHODS: Forty-nine patients referred for Gd-BOPTA-enhanced MRI were retrospectively included in this IRB-approved study, with a total of 119 lesions-90 FNH and 29 HCA. Two observers separately assessed in 2 distinct randomized reading sessions the performance of MRI with (HBP-MRI) or without (conventional MRI) the use of HBP images. Each lesion was ranked with a 5-point scale (from 1 Typical FNH to 5 Certainly not a FNH). Sensitivity, specificity, overall accuracy, and inter-observer agreement for the differentiation of FNH from HCA were calculated and compared between conventional and HBP-MRI. RESULTS: Both sensitivity (respective values of 38.9% and 97.8%), overall accuracy (respective values of 53.8% and 98.3%), and inter-observer agreement (respective values of Kappa 0.56 and 0.88) were significantly higher using HBP-MRI than with conventional MRI, with unchanged specificity (100%). The sensitivity of conventional MRI for the diagnosis of FNH was significantly lower in lesions ≤ 3 cm (20% vs. 88%). Overall, HBP could have changed lesion management in 59/119 cases (49.5%), including 53 FNH and 6 HCA with no impact in 60/119 lesions (50.5%) including all 35 lesions classified as scores 1 and 2 for the diagnosis of FNH. CONCLUSIONS: The clinical impact of HBP-MRI is mostly important for smaller than 3-cm FNH, and more limited in larger FNH lesions as well as for HCA diagnosis for which conventional MRI is already accurate. The use of extracellular contrast agents upfront could limit the required use of linear HBP contrast agents for benign hepatocellular lesion characterization. On HBP, all FNH appeared hypointense compared to adjacent liver while close to 97% of HCA appeared hypointense.
Authors: Diamantis I Tsilimigras; Amir A Rahnemai-Azar; Ioannis Ntanasis-Stathopoulos; Maria Gavriatopoulou; Demetrios Moris; Eleftherios Spartalis; Jordan M Cloyd; Sharon M Weber; Timothy M Pawlik Journal: J Gastrointest Surg Date: 2018-08-14 Impact factor: 3.452