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Hepatocellular carcinoma detection: diagnostic performance of a simulated abbreviated MRI protocol combining diffusion-weighted and T1-weighted imaging at the delayed phase post gadoxetic acid

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An Erratum to this article was published on 28 July 2017

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Abstract

Purpose

The purpose of this study was to evaluate the diagnostic performance of a “simulated” abbreviated MRI (AMRI) protocol using diffusion-weighted imaging (DWI) and T1-weighted (T1w) imaging obtained at the hepatobiliary phase (HBP) post gadoxetic acid injection alone and in combination, compared to dynamic contrast-enhanced (CE)-T1w imaging for the detection of hepatocellular carcinoma (HCC).

Methods

This was an IRB approved HIPAA compliant retrospective single institution study including patients with liver disease who underwent gadoxetic acid-enhanced MRI for HCC diagnosis. Three independent observers assessed 2 sets of images (full CE-set and AMRI including DWI+T1w-HBP). Diagnostic performance of T1w-HBP and DWI alone and in combination was compared to that of CE-set. All imaging sets included unenhanced T1w and T2w sequences. A preliminary analysis was performed to assess cost savings of AMRI protocol compared to a full MRI study.

Results

174 patients including 62 with 80 HCCs were assessed. Equivalent per-patient sensitivity and negative predictive value (NPV) were observed for DWI (85.5% and 92.2%, pooled data) and T1w-HBP (89.8% and 94.2%) (P = 0.1–0.7), while these were significantly lower for the full AMRI protocol (DWI+T1w-HBP, 80.6% and 80%, P = 0.02) when compared to CE-set (90.3% and 94.9%). Higher specificity and positive predictive value were observed for CE-set vs. AMRI (P = 0.02). The estimated cost reduction of AMRI versus full MRI ranged between 30.7 and 49.0%.

Conclusion

AMRI using DWI and T1w-HBP has a clinically acceptable sensitivity and NPV for HCC detection. This could serve as the basis for a future study assessing AMRI for HCC screening and surveillance.

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  • 28 July 2017

    An erratum to this article has been published.

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Author information

Authors and Affiliations

  1. Translational and Molecular Imaging Institute, Icahn School of Medicine at Mount Sinai, 1470 Madison Avenue, New York, NY, 10029, USA

    Cecilia Besa, Ashley Knight-Greenfield & Bachir Taouli

  2. Department of Radiology, Icahn School of Medicine at Mount Sinai, New York, NY, 10029, USA

    Cecilia Besa, Sara Lewis, Amita Kamath, Nancy Cooper & Bachir Taouli

  3. Institute for Technology Assessment, Department of Radiology, Massachusetts General Hospital, Boston, MA, USA

    Pari V. Pandharipande & Jagpreet Chhatwal

  4. Department of Radiology, New York University Langone Medical Center, New York, NY, USA

    James S. Babb

  5. Division of Cancer Prevention and Control, Department of Oncological Sciences, Icahn School of Medicine at Mount Sinai, New York, NY, USA

    Paolo Boffetta

  6. Department of Population Health Science and Policy, Icahn School of Medicine at Mount Sinai, New York, NY, USA

    Norma Padron

  7. Liver Imaging Group, Department of Radiology, University of California, San Diego, CA, USA

    Claude B. Sirlin

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  1. Cecilia Besa
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Corresponding author

Correspondence to Bachir Taouli.

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Conflict of interest

C. B. Sirlin is a consultant to Bayer Healthcare and a member of an advisory board for Bayer Healthcare.

Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

Informed consent

The Institutional Review Board at our institution approved this single-center retrospective study and the need for informed consent was waived.

Additional information

An erratum to this article is available at https://doi.org/10.1007/s00261-017-1256-7.

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Besa, C., Lewis, S., Pandharipande, P.V. et al. Hepatocellular carcinoma detection: diagnostic performance of a simulated abbreviated MRI protocol combining diffusion-weighted and T1-weighted imaging at the delayed phase post gadoxetic acid. Abdom Radiol 42, 179–190 (2017). https://doi.org/10.1007/s00261-016-0841-5

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