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- Title
Abbreviated-protocol screening MRI vs. complete-protocol diagnostic MRI for detection of hepatocellular carcinoma in patients with cirrhosis: An equivalence study using LI-RADS v2018.
- Authors
Khatri, Gaurav; Pedrosa, Ivan; Ananthakrishnan, Lakshmi; Leon, Alberto Diaz; Fetzer, David T.; Leyendecker, John; Singal, Amit G.; Xi, Yin; Yopp, Adam; Yokoo, Takeshi; de Leon, Alberto Diaz
- Abstract
<bold>Background: </bold>The high operational cost of MRI limits its utility for hepatocellular carcinoma (HCC) screening. Abbreviated-protocol dynamic contrast-enhanced MRI (aMRI) may help lower cost while maintaining the high accuracy of complete-protocol diagnostic MRI (cMRI).<bold>Purpose: </bold>To compare aMRI to cMRI for HCC detection in cirrhosis patients.<bold>Study Type: </bold>Cross-sectional study.<bold>Study Population: </bold>Cirrhosis patients undergoing MRI for suspected HCC.<bold>Field Strength/sequence: </bold>1.5T and 3T; aMRI (coronal T2 -weighted, axial dynamic contrast-enhanced T1 -weighted fat-suppressed sequences); cMRI (aMRI sequences and unenhanced axial T2 -, T1 -, and diffusion-weighted sequences).<bold>Assessment: </bold>From each cMRI, an abbreviated exam was created by extracting only the aMRI sequences. Five radiologists independently reviewed aMRI and cMRI and assigned per-patient screening results by the presence/absence of any actionable observation per Liver Imaging and Reporting Data System v2018 (LI-RADS 4, 5, M, or TIV categories). Per-patient HCC status was determined by the composite reference standard of histopathology, follow-up imaging, consensus expert panel imaging review, and clinical follow-up.<bold>Statistical Tests: </bold>Interreader agreement between aMRI and cMRI was compared with that of cMRI and tested for interchangeability against a tolerance margin of 0.05. Per-patient screening sensitivity, specificity, and accuracy were compared between aMRI and cMRI and tested for equivalence against a tolerance margin of 0.05.<bold>Results: </bold>In 93 cirrhosis patients, five radiologists recorded on average 121 liver observations. Interreader screening agreement probability (and 95% confidence interval confidence interval [CI]) was 0.914 [0.900, 0.926] between aMRI and cMRI, and 0.927 [0.908, 0.942] for cMRI; their difference was within the 0.05 margin for interchangeability. In 86 patients in whom a final HCC status could be determined, the detection sensitivity and specificity of aMRI was 0.921 [0.864, 0.956] and 0.886 [0.844, 0.918], within the 5% equivalence margin to cMRI, 0.936 [0.881, 0.965] and 0.883 [0.840, 0.915], respectively.<bold>Data Conclusion: </bold>Abbreviated-protocol screening MRI is interchangeable with, and equivalent to, complete-protocol diagnostic MRI for per-patient HCC detection in cirrhosis.<bold>Level Of Evidence: </bold>4 Technical Efficacy: Stage 6 J. Magn. Reson. Imaging 2020;51:415-425.
- Subjects
HEPATOCELLULAR carcinoma; CIRRHOSIS of the liver; CONFIDENCE intervals; CONTRAST-enhanced magnetic resonance imaging; MATHEMATICAL equivalence; LIVER tumors; CROSS-sectional method; MAGNETIC resonance imaging; CONTRAST media; RETROSPECTIVE studies; PSYCHOLOGICAL tests; RESEARCH funding; DISEASE complications
- Publication
Journal of Magnetic Resonance Imaging, 2020, Vol 51, Issue 2, p415
- ISSN
1053-1807
- Publication type
journal article
- DOI
10.1002/jmri.26835