Abbreviated‐protocol screening MRI vs. complete‐protocol diagnostic MRI for detection of hepatocellular carcinoma in patients with cirrhosis: An equivalence study using LI‐RADS v2018. Issue 2 (18th June 2019)

• Record Type: Journal Article
• Authors: Khatri, Gaurav; Pedrosa, Ivan; Ananthakrishnan, Lakshmi; de Leon, Alberto Diaz; Fetzer, David T.; Leyendecker, John; Singal, Amit G.; Xi, Yin; Yopp, Adam; Yokoo, Takeshi
• Is Part Of: Journal of magnetic resonance imaging. Volume 51:Issue 2(2020)
• Page Start: 415
• Page End: 425
• Publication Date: 2019-06-18
• Subjects: hepatocellular carcinoma -- liver cancer -- cirrhosis -- screening -- early detection -- abbreviated MRI -- LI‐RADS; Magnetic resonance imaging -- Periodicals; 616
• DOI: 10.1002/jmri.26835
• Languages: English
• ISSNs: 1053-1807

Abstract

Abstract : Background: The high operational cost of MRI limits its utility for hepatocellular carcinoma (HCC) screening. Abbreviated‐protocol dynamic contrast‐enhanced MRI (aMRI) may help lower cost while maintaining the high accuracy of complete‐protocol diagnostic MRI (cMRI). Purpose: To compare aMRI to cMRI for HCC detection in cirrhosis patients. Study Type: Cross‐sectional study. Study Population: Cirrhosis patients undergoing MRI for suspected HCC. Field Strength/Sequence: 1.5T and 3T; aMRI (coronal T2 ‐weighted, axial dynamic contrast‐enhanced T1 ‐weighted fat‐suppressed sequences); cMRI (aMRI sequences and unenhanced axial T2 ‐, T1 ‐, and diffusion‐weighted sequences). Assessment: From each cMRI, an abbreviated exam was created by extracting only the aMRI sequences. Five radiologists independently reviewed aMRI and cMRI and assigned per‐patient screening results by the presence/absence of any actionable observation per Liver Imaging and Reporting Data System v2018 (LI‐RADS 4, 5, M, or TIV categories). Per‐patient HCC status was determined by the composite reference standard of histopathology, follow‐up imaging, consensus expert panel imaging review, and clinical follow‐up. Statistical Tests: Interreader agreement between aMRI and cMRI was compared with that of cMRI and tested for interchangeability against a tolerance margin of 0.05. Per‐patient screening sensitivity, specificity, and accuracy were compared between aMRI and cMRI and tested for equivalence against a tolerance margin of 0.05. Results: In 93 cirrhosis patients, five radiologists recorded on average 121 liver observations. Interreader screening agreement probability (and 95% confidence interval confidence interval [CI]) was 0.914 [0.900, 0.926] between aMRI and cMRI, and 0.927 [0.908, 0.942] for cMRI; their difference was within the 0.05 margin for interchangeability. In 86 patients in whom a final HCC status could be determined, the detection sensitivity and specificity of aMRI was 0.921 [0.864, 0.956] and 0.886 [0.844, 0.918], within the 5% equivalence margin to cMRI, 0.936 [0.881, 0.965] and 0.883 [0.840, 0.915], respectively. Data Conclusion: Abbreviated‐protocol screening MRI is interchangeable with, and equivalent to, complete‐protocol diagnostic MRI for per‐patient HCC detection in cirrhosis. Level of Evidence: 4 Technical Efficacy: Stage 6 J. Magn. Reson. Imaging 2020;51:415–425.