Evaluation of washout using subtraction MRI for the diagnosis of hepatocellular carcinoma in cirrhotic patients with spontaneously T1-hyperintense nodules - 26/08/23
, Maxime Ronot b, Marine Roux c, Roberto Cannella b, d, e, Jérôme Lebigot a, c, Christophe Aubé a, c, Anita Paisant a, c
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Highlights |
• | The use of portal or delayed phase subtraction MR images using extracellular agent leads to a drop in specificity using LI-RADS v2018 (67% vs. 33%; P = 0.553) and EASL v2018 (72% vs. 39%; P = 0.553) criteria. |
• | The use of portal venous phase, delayed/transitional phase or hepatobiliary phase subtraction MR images with hepatobiliary agent leads to a drop in specificity using LI-RADS v2018, EASL v2018, KLCA-NCC v2018, and APASL v2017 criteria. |
• | The use of portal venous phase or delayed/transitional phase subtraction MR images increases the detection of capsule in both hepatocellular carcinoma and non-hepatocellular carcinoma nodules. |
Abstract |
Purpose |
The purpose of this study was to assess the value of subtraction imaging on post-arterial phase images (i.e., portal venous, delayed/transitional and hepatobiliary phases) for the non-invasive diagnosis of hepatocellular carcinoma (HCC) in spontaneously hyperintense nodules on T1-weighted imaging in patients with cirrhosis.
Materials and methods |
Forty-five patients with a total 55 hepatic nodules that were spontaneously hyperintense on T1-weighted images were initially retrieved. All patients underwent MRI examination of the liver using extracellular agent. Each nodule was assessed for sensitivity and specificity using LI-RADS (Liver Imaging Reporting and Data System) during two reading sessions performed first without then with subtraction images on post-arterial phase images. The final standard of reference was defined by a step-by-step algorithm previously published combining histology, typical imaging, alfa fetoprotein and follow-up.
Results |
Forty-six nodules (26 HCC) in 39 patients with cirrhosis were analyzed. Using LI-RADS, the sensitivity and specificity for the diagnosis of HCC were 64% (95% CI: 41–83) and 67% (95% CI: 41–87) without subtraction; and 73% (95% CI: 50–89) (P > 0.999) and 33% (95% CI: 13–59) (P = 0.553) on subtraction imaging using extracellular contrast agent. Fifty-five percent (22/40) of nodules displayed a washout without subtraction and 70% (28/40) did so on subtraction imaging obtained with extracellular contrast agent. Twenty nodules out of 40 (50%) were classified LI-RADS 5 without subtraction, and 28 out of 40 nodules (70%) with subtraction.
Conclusion |
The results of this study suggest that the use of subtraction imaging on post-arterial phase images (i.e., PVP, DP/TP and HBP) is not relevant for the non-invasive diagnosis of HCC for spontaneously hyperintense nodules on T1-weighted images in patients with liver cirrhosis.
El texto completo de este artículo está disponible en PDF.Keywords : Diagnostic imaging, Hepatocellular carcinoma, Liver neoplasm, Magnetic resonance imaging, Subtraction imaging
Abbreviations : AP, APASL, APHE, CI, DP, EASL, ECA, HBA, HBP, HCC, KLCA-NCC, LI-RADS, PVP, SD, TP
Esquema
Vol 104 - N° 9
P. 427-434 - septembre 2023 Regresar al número
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