Department of Radiology and Interventional Radiology, Lausanne University Hospital and Lausanne University, Lausanne, Switzerland.
Department of Gastro-enterology, Lausanne University Hospital and Lausanne University, Lausanne, Switzerland.
Eur Radiol. 2023 Oct;33(10):6929-6938. doi: 10.1007/s00330-023-09906-4. Epub 2023 Jul 18.
This study aimed to compare two abbreviated MRI (AMRI) protocols to complete MRI for HCC detection: non-contrast (NC)-AMRI without/with alpha foetoprotein (AFP) and dynamic contrast-enhanced (Dyn)-AMRI.
This retrospective single-center study included 351 patients (M/F: 264/87, mean age: 57y) with chronic liver disease, who underwent MRI for HCC surveillance between 2014 and 2020. Two reconstructed AMRI sets were obtained based on complete MRI: NC-AMRI (T2-weighted imaging (WI) + diffusion-WI) and Dyn-AMRI (T2-WI + dynamic T1-WI) and were assessed by 2 radiologists who reported all suspicious lesions, using LI-RADS/adapted LI-RADS classification. The reference standard was based on all available patient data. Inter-reader agreement was assessed and MRI diagnostic performance was compared to the reference standard.
The reference standard demonstrated 83/351 HCC-positive patients (prevalence: 23.6%, median size: 22 mm, and positive MRIs: 83/631). Inter-reader agreement was substantial for all sets. Sensitivities of Dyn-AMRI and complete MRI (both 92.8%) were similar, higher than NC-AMRI (72.3%, p < 0.001). Specificities were not different between sets. NC-AMRI + AFP (92.8%) had similar sensitivity to Dyn-AMRI and complete MRI. In patients with small size HCCs (≤ 2 cm), sensitivities of Dyn-AMRI (85.3%) and complete MRI (88.2%) remained similar (p = 0.564), also outperforming NC-AMRI (52.9%, p < 0.05). NC-AMRI + AFP had similar sensitivity (88.2%) to Dyn-AMRI and complete MRI (p = 0.706 and p = 1, respectively).
Dyn-AMRI has similar diagnostic performance to complete MRI for HCC detection, while both outperform NC-AMRI, especially for small size HCCs. NC-AMRI + AFP demonstrates similar sensitivity to Dyn-AMRI and complete MRI.
Due to the low sensitivity of ultrasound for hepatocellular screening, new screening methods are needed. Abbreviated MRI (AMRI) is a candidate, especially non-contrast AMRI with serum alpha foetoprotein as the acquisition time is low, without the need for contrast medium injection.
• Dynamic contrast-enhanced abbreviated MRI using extracellular gadolinium-based contrast agent and complete MRI have similar diagnostic performance for hepatocellular carcinoma detection in an at-risk population. • Non-contrast abbreviated MRI with alpha foetoprotein has similar diagnostic performance to dynamic contrast-enhanced abbreviated MRI and complete MRI, including when considering small size hepatocellular carcinoma ≤ 2 cm. • Non-contrast abbreviated MRI and dynamic contrast-enhanced abbreviated MRI can be performed in 7 and 10 min, excluding patient setup time.
本研究旨在比较两种简化磁共振成像（AMRI）方案与完整 MRI 用于 HCC 检测：不包括/包括甲胎蛋白（AFP）的非对比（NC）-AMRI 和动态对比增强（Dyn）-AMRI。
本回顾性单中心研究纳入了 2014 年至 2020 年间因 HCC 监测而行 MRI 的 351 例慢性肝病患者（男/女：264/87，平均年龄：57 岁）。基于完整 MRI 获得了两个重建的 AMRI 集：NC-AMRI（T2 加权成像（WI）+扩散-WI）和 Dyn-AMRI（T2-WI+动态 T1-WI），由 2 名放射科医生进行评估，他们使用 LI-RADS/改编的 LI-RADS 分类报告所有可疑病变。参考标准基于所有可用的患者数据。评估了读者间的一致性，并将 MRI 诊断性能与参考标准进行了比较。
参考标准显示 83/351 例 HCC 阳性患者（患病率：23.6%，中位大小：22mm，阳性 MRI：83/631）。所有集合的读者间一致性均为中等。Dyn-AMRI 和完整 MRI 的灵敏度（均为 92.8%）相似，高于 NC-AMRI（72.3%，p<0.001）。特异性在各组之间没有差异。NC-AMRI+AFP（92.8%）与 Dyn-AMRI 和完整 MRI 的灵敏度相似。在小 HCCs（≤2cm）患者中，Dyn-AMRI（85.3%）和完整 MRI（88.2%）的灵敏度仍然相似（p=0.564），也优于 NC-AMRI（52.9%，p<0.05）。NC-AMRI+AFP 的灵敏度与 Dyn-AMRI 和完整 MRI 相似（p=0.706 和 p=1）。
Dyn-AMRI 对 HCC 检测的诊断性能与完整 MRI 相似，而两者均优于 NC-AMRI，尤其是对于小 HCCs。NC-AMRI+AFP 与 Dyn-AMRI 和完整 MRI 的灵敏度相似。
由于超声对肝细胞癌筛查的敏感性较低，因此需要新的筛查方法。简化磁共振成像（AMRI）是一种候选方法，特别是非对比 AMRI 结合血清甲胎蛋白作为采集时间较低，无需注射对比剂。
• 使用细胞外钆基造影剂的动态对比增强简化 MRI 和完整 MRI 在高危人群中对肝细胞癌检测具有相似的诊断性能。
• 非对比简化 MRI 结合 AFP 与动态对比增强简化 MRI 和完整 MRI 的诊断性能相似，包括考虑小 HCCs（≤2cm）时。
• 非对比简化 MRI 和动态对比增强简化 MRI 可在 7 分钟和 10 分钟内完成，不包括患者准备时间。
