Gadoxetate-enhanced abbreviated MRI is highly accurate for hepatocellular carcinoma screening
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HEPATOBILIARY-PANCREAS
Gadoxetate-enhanced abbreviated MRI is highly accurate for hepatocellular carcinoma screening Naik Vietti Violi 1,2,3 & Sara Lewis 1,2 & Joseph Liao 2 & Miriam Hulkower 2 & Gabriela Hernandez-Meza 4 & Katherine Smith 5 & James S. Babb 6 & Xing Chin 2 & Joseph Song 2 & Daniela Said 1,2,7 & Shingo Kihira 2 & Claude B. Sirlin 8 & Scott B. Reeder 9 & Mustafa R. Bashir 10 & Kathryn J. Fowler 8 & Bart S. Ferket 11 & Keith Sigel 12 & Bachir Taouli 1,2 Received: 10 February 2020 / Revised: 29 April 2020 / Accepted: 5 June 2020 # European Society of Radiology 2020
Abstract Objectives The primary objective was to compare the performance of 3 different abbreviated MRI (AMRI) sets extracted from a complete gadoxetate-enhanced MRI obtained for hepatocellular carcinoma (HCC) screening. Secondary objective was to perform a preliminary cost-effectiveness analysis, comparing each AMRI set to published ultrasound performance for HCC screening in the USA. Methods This retrospective study included 237 consecutive patients (M/F, 146/91; mean age, 58 years) with chronic liver disease who underwent a complete gadoxetate-enhanced MRI for HCC screening in 2017 in a single institution. Two radiologists independently reviewed 3 AMRI sets extracted from the complete exam: non-contrast (NC-AMRI: T2-weighted imaging (T2wi)+diffusion-weighted imaging (DWI)), dynamic-AMRI (Dyn-AMRI: T2wi+DWI+dynamic T1wi), and hepatobiliary phase AMRI (HBP-AMRI: T2wi+DWI+T1wi during the HBP). Each patient was classified as HCC-positive/HCC-negative based on the reference standard, which consisted in all available patient data. Diagnostic performance for HCC detection was compared between sets. Estimated set characteristics, including historical ultrasound data, were incorporated into a microsimulation model for cost-effectiveness analysis. Results The reference standard identified 13/237 patients with HCC (prevalence, 5.5%; mean size, 33.7 ± 30 mm). Pooled sensitivities were 61.5% for NC-AMRI (95% confidence intervals, 34.4–83%), 84.6% for Dyn-AMRI (60.8–95.1%), and 80.8% for HBP-AMRI (53.6–93.9%), without difference between sets (p range, 0.06–0.16). Pooled specificities were 95.5% (92.4–97.4%), 99.8% (98.4–100%), and 94.9% (91.6–96.9%), respectively, with a significant difference between Dyn-AMRI and the other sets (p < 0.01). All AMRI methods were effective compared with ultrasound, with life-year gain of 3–12 months against incremental costs of US$ < 12,000. Electronic supplementary material The online version of this article (https://doi.org/10.1007/s00330-020-07014-1) contains supplementary material, which is available to authorized users. * Bachir Taouli [email protected] 1
BioMedical Engineering and Imaging Institute, Icahn School of Medicine at Mount Sinai, New York, NY, USA
2
Department of Diagnostic, Molecular and Interventional Radiology, Icahn School of Medicine at Mount Sinai, 1470 Madison Avenue, New York, NY 10029, USA
3
Department of Radiology, Lausanne University Hospital, Lausanne, Switzerland
4
Icahn
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