Reinterpretation of Outside Hospital MRI Abdomen Examinations in Patients With Cirrhosis: Is the OPTN Mandate Necessary?

OBJECTIVE

The objective of our study was to determine the relevance of a policy mandating reinterpretation of outside abdominal MRI examinations in patients with cirrhosis at risk for hepatocellular carcinoma (HCC).

MATERIALS AND METHODS

A random subset (n = 125) of consecutive outside-hospital MRI abdomen examinations (n = 473) performed in subjects with cirrhosis and reinterpreted at a tertiary care center by one of 11 fellowship-trained radiologists was included. The original and reinterpreted reports were compared in consensus by two hepatobiliary imaging experts; one hepatologist determined the clinical impact. Each was blinded to outcome. The primary outcome was discrepancies relevant to the Organ Procurement and Transplantation Network (OPTN), including diagnosis of HCC and exceeding the Milan criteria for transplantation. Rates were compared with the McNemar test.

RESULTS

HCC was diagnosed in 34% (43/125) of reinterpretations; of these, 44% (19/43) were concordant, 42% (18/43) originally were considered suspicious but not diagnostic of HCC, and 14% (6/43) were discordant. The Milan criteria were exceeded in 21% (26/125) of reinterpretations; of these, 73% (19/26) were concordant and 27% (7/26) were discordant. Overall, 10% (12/125) of subjects had a discrepant diagnosis of HCC, and 10% (12/125) of subjects had discrepant Milan status; 26% (11/43) of masses diagnosed to be HCC had been biopsied at the original institution. Original reports were significantly more likely to be missing major details (26% [32/125] vs 0.8% [1/125], p < 0.001) or difficult to understand (18% [23/125] vs 0.8% [1/125], p < 0.001). Predicted clinical management differed in 50% (62/125) of reinterpretations.

CONCLUSION

The OPTN mandate for expert interpretation of liver MRI in patients with cirrhosis appears justified.