How frequently does hepatocellular carcinoma develop in at-risk patients with a negative liver MRI examination with intr
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HEPATOBILIARY
How frequently does hepatocellular carcinoma develop in at‑risk patients with a negative liver MRI examination with intravenous Gadobenate dimeglumine? Islam H. Zaki1,2 · Erin Shropshire1 · Shuaiqi Zhang4 · Dong Xiao4 · Benjamin Wildman‑Tobriner1 · Daniele Marin1 · Rajan T. Gupta1 · Alaattin Erkanli4 · Redon C. Nelson1 · Mustafa R. Bashir1,2,3 Received: 11 June 2020 / Revised: 1 September 2020 / Accepted: 10 September 2020 © Springer Science+Business Media, LLC, part of Springer Nature 2020
Abstract Objective To determine the rate of development of clinically significant liver nodules (LR-4, LR-5, LR-M) after a negative MRI in an HCC screening population. Methods This retrospective study included patients at risk of developing HCC requiring imaging surveillance who had undergone multiphase Gadobenate dimeglumine-enhanced MRI that was negative and had follow up LI-RADS compliant multiphase CTs or MRIs for at least 12 months or positive follow-up within 12 months. Follow-up examinations were classified as negative (no nodules or only LR-1 nodules) or positive (nodule other than LR-1). Time-to-first positive examination, types of nodules, and cumulative incidence of nodule development were recorded. Results 204 patients (mean age 58.9 ± 10.2 years, 128 women), including 172 with cirrhosis, were included. Based CT/MRI follow-up (median 35 months, range 12–80 months), the overall cumulative incidence of developing a nodule was 10.5%. Cumulative incidence of nodule development was: 0.5% at 6–9 months and 2.1% at 12 ± 3 months, including one LR-4 nodule, one LR-M nodule, and two LR-3 nodules. The cumulative incidence of clinically significant nodule development was 1.1% at 9–15 months. 70% (143/204) of patients also underwent at least one US follow-up, and no patient developed a positive US examination following index negative MRI. Conclusion Clinically significant liver nodules develop in 1.1% of at-risk patients in the first year following negative MRI. While ongoing surveillance is necessary for at-risk patients, our study suggests than longer surveillance intervals after a negative MRI may be reasonable and that further research is needed to explore this possibility. Keywords Liver imaging reporting and data system · Surveillance · Hepatocellular carcinoma · MRI
* Mustafa R. Bashir [email protected]
Alaattin Erkanli [email protected]
Islam H. Zaki [email protected]
Redon C. Nelson [email protected]
Erin Shropshire [email protected]
1
Shuaiqi Zhang [email protected]
Department of Radiology, Duke University Medical Center, Box 3808, Durham, NC 27710, USA
2
Dong Xiao [email protected]
Center for Advanced Magnetic Resonance Development (CAMRD), Duke University Medical Center, Box 3808, Durham, NC 27710, USA
3
Benjamin Wildman‑Tobriner benjamin.wildman‑[email protected]
Division of Gastroenterology, Department of Medicine, Duke University Medical Center, Durham, NC 27710, USA
4
Department of Biostatistics and Bioinformatics, Duke Univ
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