Multicenter Validation of Abbreviated MRI for Detecting Early-Stage Hepatocellular Carcinoma

Abstract

Background Abbreviated MRI is a proposed paradigm shift for hepatocellular carcinoma (HCC) surveillance, but data on its performance are lacking for histopathologically confirmed early-stage HCC. Purpose To evaluate the sensitivity and specificity of dynamic contrast-enhanced abbreviated MRI for early-stage HCC detection, using surgical pathologic findings as the reference standard. Materials and Methods This retrospective study was conducted at three U.S. liver transplant centers in patients with cirrhosis who underwent liver resection or transplant between January 2009 and December 2019 and standard "full" liver MRI with and without contrast enhancement within 3 months before surgery. Patients who had HCC-directed treatment before surgery were excluded. Dynamic abbreviated MRI examinations were simulated from the presurgical full MRI by selecting the coronal T2-weighted and axial three-dimensional fat-suppressed T1-weighted dynamic contrast-enhanced sequences at precontrast, late arterial, portal venous, and delayed phases. Two abdominal radiologists at each center independently interpreted the simulated abbreviated examinations with use of the Liver Imaging Reporting and Data System version 2018. Patients with any high-risk liver observations (>LR-3) were classified as positive; otherwise, they were classified as negative. With liver pathologic findings as the reference standard for the presence versus absence of early-stage HCC, the sensitivity, specificity, and their 95% CIs were calculated. Logistic regression was used to identify factors associated with correct classification. Results A total of 161 patients with early-stage HCC (median age, 62 years [IQR, 58-67 years]; 123 men) and 138 patients without HCC (median age, 55 years [IQR, 47-63 years]; 85 men) were confirmed with surgical pathologic findings. The sensitivity and specificity of abbreviated MRI were 88.2% (142 of 161 patients) (95% CI: 83.5, 92.5) and 89.1% (123 of 138 patients) (95% CI: 84.4, 93.8), respectively. Sensitivity was lower for Child-Pugh class B or C versus Child-Pugh class A cirrhosis (64.1% vs 94.2%; P < .001). Conclusion With surgical pathologic findings as the reference standard, dynamic abbreviated MRI had high sensitivity and specificity for early-stage hepatocellular carcinoma detection in patients with compensated cirrhosis but lower sensitivity in those with decompensated cirrhosis. © RSNA, 2023 Supplemental material is available for this article. See also the editorial by Kim in this issue.

Graphical abstract

Figure 1:

Patient eligibility flow diagram. The final study sample is indicated by rounded rectangles. HCC = hepatocellular carcinoma, LI-RADS = Liver Imaging Reporting and Data System.

Figure 2:

(A–D) Three-dimensional axial dynamic contrast-enhanced T1-weighted images (liver acquisition with volume acquisition, or LAVA) with frequency-selective fat suppression acquired on a 1.5-T GE Signa HDxt scanner in a 64-year-old man with Child-Pugh class A cirrhosis from chronic hepatitis C infection. Examination quality was rated as adequate by both readers. The images from this simulated dynamic abbreviated MRI examination demonstrate a 2.1-cm observation (arrow) in segment II with nonrim arterial phase hyper-enhancement (A) and delayed washout (C), classified as Liver Imaging Reporting and Data System category LR-5 and confirmed as poorly differentiated hepatocellular carcinoma on the left lobectomy surgical specimen.

Figure 3:

(A–D) Three-dimensional axial dynamic contrast-enhanced T1-weighted images (mDixon sequence) acquired on a 1.5-T Philips Ingenia scanner in a 66-year-old woman with Child-Pugh class C cirrhosis from alcohol use. Examination quality was rated as adequate by both readers. The images from this simulated dynamic abbreviated MRI examination demonstrate no high-risk (Liver Imaging Reporting and Data System category LR-4, LR-5, or LR-M) observation but show a T1-hypointense observation (arrow) in the periphery of segment VII, with enlarging peripheral nodular enhancement at sequential postcontrast phases consistent with hemangioma, as well as a simple cyst. These findings, including the absence of hepatocellular carcinoma, were confirmed on the liver explant specimen.