Anita Paisant1, Valérie Vilgrain2, Jérémie Riou3, Frédéric Oberti4, Olivier Sutter5, Valérie Laurent6, Agnès Rodes7, Boris Guiu8, Christophe Cassinotto9, Hervé Trillaud10, Ivan Bricault11, Sophie Michalak12, Onorina Bruno13, Maxime Ronot2, Christophe Aubé14. 1. Département de Radiologie, Centre Hospitalier Universitaire d'Angers, 49933 Angers, France; Laboratoire HIFIH, EA 3859, Universitaire d'Angers, 49045 Angers, France. Electronic address: anita.paisant@chu-angers.fr. 2. Département de Radiologie, Hôpital Beaujon, Hôpitaux Paris Nord Val de Seine (AP-HP) 92110, Clichy, France; Université Paris Diderot, Sorbonne Paris Cité, CRI, U1149, 75000 Paris, France. 3. Université d'Angers, UFR Santé, 49000 Angers, France; MINT UMR INSERM 1066, CNRS 6021, Université d'Angers, 49000 Angers, France. 4. Laboratoire HIFIH, EA 3859, Universitaire d'Angers, 49045 Angers, France; Service de Gastroenterologie et Hépatologie, Centre Hospitalier Universitaire d'Angers, 49933 Angers, France. 5. Service de Radiologie, Hôpital Jean Verdier, Hôpitaux Universitaires Paris-Seine-Saint-Denis (AP-HP), 93140 Bondy, France. 6. Département de Radiologie, Centre Hospitalier Universitaire de Nancy, Hôpital de Brabois, 54500 Vandoeuvre-lès-Nancy, France. 7. Département de Radiologie, Hôpital de la Croix Rousse, Centre Hospitalier Universitaire de Lyon, 69004 Lyon, France. 8. Département de Radiologie, INSERM U896, CHU Saint-Eloi, Université de Montpellier, 34295 Montpellier, France. 9. CHU Bordeaux Department of Diagnostic and Interventional Radiology, F-33000 Bordeaux, France. 10. CHU Bordeaux Department of Diagnostic and Interventional Radiology, F-33000 Bordeaux, France; Universitaire de Bordeaux, EA Imotion, F-33000 Bordeaux, France. 11. Département d'Imagerie, Radiologie et Imagerie Médicale, CHU, 38000 Grenoble, France; Laboratory of Techniques for Biomedical Engineering and Complexity Management - Informatics, Mathematics and Applications, Université 38000 Grenoble Alpes, Grenoble, France. 12. Département d'Anatomopatologie, Centre Hospitalier Universitaire d'Angers, Université d'Angers, 49933 Angers, France. 13. Département de Radiologie, Hôpital Beaujon, Hôpitaux Paris Nord Val de Seine (AP-HP) 92110, Clichy, France. 14. Département de Radiologie, Centre Hospitalier Universitaire d'Angers, 49933 Angers, France; Laboratoire HIFIH, EA 3859, Universitaire d'Angers, 49045 Angers, France.
Abstract
BACKGROUND & AIMS: The aim of this study was to use a head-to-head nodule comparison to compare the performance of extracellular contrast agent MRI (ECA-MRI) with that of hepatobiliary contrast agent MRI (HBA-MRI) for the non-invasive diagnosis of small hepatocellular carcinomas (HCCs). METHODS: Between August 2014 and October 2017, 171 patients with cirrhosis, each with 1 to 3 nodules measuring 1-3 cm, were enrolled across 8 centers. All patients underwent both an ECA-MRI and an HBA-MRI within a month. A non-invasive diagnosis of HCC was made when a nodule exhibited arterial phase hyper-enhancement (APHE) with washout at the portal venous phase (PVP) and/or delayed phase (DP) for ECA-MRI, or the PVP and/or HB phase (HBP) for HBA-MRI. The gold standard was defined by using a previously published composite algorithm. RESULTS: A total of 225 nodules, of which 153 were HCCs and 72 were not, were included. The sensitivites of both MRI techniques were similar. Specificity was 83.3% (95% CI 72.7-91.1) for ECA-MRI and 68.1% (95% CI 56.0-78.6) for HBA-MRI. In terms of HCC diagnosis on ECA-MRI, 138 nodules had APHE, 84 had washout at PVP, and 104 at DP; on HBA-MRI, 128 nodules had APHE, 71 had washout at PVP, and 99 at HBP. For nodules 2-3 cm in size, sensitivity and specificity were similar between the 2 approaches. For nodules 1-2 cm in size, specificity dropped to 66.1% (95% CI 52.2-78.2) for HBA-MRI vs. 85.7% (95% CI 73.8-93.6) for ECA-MRI. CONCLUSIONS: HBA-MRI specificity is lower than that of ECA-MRI for diagnosing small HCCs in patients with cirrhosis. These results raise the question of the proper use of HBA-MRI in algorithms for the non-invasive diagnosis of small HCCs. LAY SUMMARY: There are 2 magnetic resonance imaging (MRI)-based approaches available for the non-invasive diagnosis of hepatocellular carcinoma (HCC), using either extracellular or hepatobiliary contrast agents. The current results showed that the sensitivity of MRI with hepatobiliary contrast agents was similar to that with extracellular contrast agents, but the specificity was lower. Thus, hepatobiliary contrast agent-based MRI, although detailed in international guidelines, should be used with caution for the non-invasive diagnosis of HCC. CLINICAL TRIAL NUMBER: NCT00848952.
BACKGROUND & AIMS: The aim of this study was to use a head-to-head nodule comparison to compare the performance of extracellular contrast agent MRI (ECA-MRI) with that of hepatobiliary contrast agent MRI (HBA-MRI) for the non-invasive diagnosis of small hepatocellular carcinomas (HCCs). METHODS: Between August 2014 and October 2017, 171 patients with cirrhosis, each with 1 to 3 nodules measuring 1-3 cm, were enrolled across 8 centers. All patients underwent both an ECA-MRI and an HBA-MRI within a month. A non-invasive diagnosis of HCC was made when a nodule exhibited arterial phase hyper-enhancement (APHE) with washout at the portal venous phase (PVP) and/or delayed phase (DP) for ECA-MRI, or the PVP and/or HB phase (HBP) for HBA-MRI. The gold standard was defined by using a previously published composite algorithm. RESULTS: A total of 225 nodules, of which 153 were HCCs and 72 were not, were included. The sensitivites of both MRI techniques were similar. Specificity was 83.3% (95% CI 72.7-91.1) for ECA-MRI and 68.1% (95% CI 56.0-78.6) for HBA-MRI. In terms of HCC diagnosis on ECA-MRI, 138 nodules had APHE, 84 had washout at PVP, and 104 at DP; on HBA-MRI, 128 nodules had APHE, 71 had washout at PVP, and 99 at HBP. For nodules 2-3 cm in size, sensitivity and specificity were similar between the 2 approaches. For nodules 1-2 cm in size, specificity dropped to 66.1% (95% CI 52.2-78.2) for HBA-MRI vs. 85.7% (95% CI 73.8-93.6) for ECA-MRI. CONCLUSIONS: HBA-MRI specificity is lower than that of ECA-MRI for diagnosing small HCCs in patients with cirrhosis. These results raise the question of the proper use of HBA-MRI in algorithms for the non-invasive diagnosis of small HCCs. LAY SUMMARY: There are 2 magnetic resonance imaging (MRI)-based approaches available for the non-invasive diagnosis of hepatocellular carcinoma (HCC), using either extracellular or hepatobiliary contrast agents. The current results showed that the sensitivity of MRI with hepatobiliary contrast agents was similar to that with extracellular contrast agents, but the specificity was lower. Thus, hepatobiliary contrast agent-based MRI, although detailed in international guidelines, should be used with caution for the non-invasive diagnosis of HCC. CLINICAL TRIAL NUMBER: NCT00848952.
Authors: Saleh A Alqahtani; Faisal M Sanai; Ashwaq Alolayan; Faisal Abaalkhail; Hamad Alsuhaibani; Mazen Hassanain; Waleed Alhazzani; Abdullah Alsuhaibani; Abdullah Algarni; Alejandro Forner; Richard S Finn; Waleed K Al-Hamoudi Journal: Saudi J Gastroenterol Date: 2020-10 Impact factor: 2.485
Authors: Josep M Llovet; Robin Kate Kelley; Augusto Villanueva; Amit G Singal; Eli Pikarsky; Sasan Roayaie; Riccardo Lencioni; Kazuhiko Koike; Jessica Zucman-Rossi; Richard S Finn Journal: Nat Rev Dis Primers Date: 2021-01-21 Impact factor: 52.329
Authors: Alexandra Petukhova-Greenstein; Tal Zeevi; Junlin Yang; Nathan Chai; Paul DiDomenico; Yanhong Deng; Maria Ciarleglio; Stefan P Haider; Ifeyinwa Onyiuke; Rohil Malpani; MingDe Lin; Ahmet S Kucukkaya; Luzie A Gottwald; Bernhard Gebauer; Margarita Revzin; John Onofrey; Lawrence Staib; Gowthaman Gunabushanam; Tamar Taddei; Julius Chapiro Journal: J Vasc Interv Radiol Date: 2022-04-20 Impact factor: 3.682