title: Combined SPIO-gadolinium magnetic resonance imaging in cirrhotic patients: negative predictive value and role in screening for hepatocellular carcinoma.
abstract: BACKGROUND
  The objective of our study was to assess the negative predictive value (NPV) of double-contrast MRI (DC-MRI) with SPIO and gadolinium, and to determine the role of DC-MRI in screening for hepatocellular carcinoma (HCC) in cirrhotic patients.
  
  
  METHODS
  We retrospectively included 160 DC-MRI scans done as second-line investigations in 119 patients with cirrhosis over a 25-month period. Two radiologists independently classified the MRI scans as strongly suggesting HCC (HCC Group), showing benign nodules (benign nodules Group), showing no nodules (no-nodules Group) or indeterminate; they assigned a diagnostic confidence score (DCS) using a 0-10 scale. The reference standard was histology or results of follow-up investigations. Mean follow-up was 16.9 months (12-28 months).
  
  
  RESULTS
  The radiologists disagreed for two scans (kappa = 0.98). Of 112 scans [benign nodules Group (n = 32) and no-nodules Group (n = 80)], 11 were excluded (3 patients lost to follow-up and 8 who died with no known cancer) while a HCC was detected during follow-up in 8 patients, yielding a NPV of 92% (93/101) (95% confidence interval, 85%-97%). The DCS was in the 4-6 range (indicating uncertainty) for only 6 (3.75%) scans.
  
  
  CONCLUSIONS
  DC-MRI is reliable and reproducible. Its high NPV suggests a role as a second-line investigation after ultrasonography, for HCC screening.
authors.affiliation: Radiology Departement, CHU le Bocage, University Hospital of Dijon, Boulevard Maréchal de Lattre de Tassigny, Dijon, 21000, France. boris.guiu@chu-dijon.fr
authors.forename: Boris
authors.initials: B
authors.lastname: Guiu
authors.forename: Romaric
authors.initials: R
authors.lastname: Loffroy
authors.forename: Douraied
authors.initials: D
authors.lastname: Ben Salem
authors.forename: Come
authors.initials: C
authors.lastname: Lepage
authors.forename: Séverine
authors.initials: S
authors.lastname: Guiu
authors.forename: Serge
authors.initials: S
authors.lastname: Aho
authors.forename: Jean-Louis
authors.initials: JL
authors.lastname: Jouve
authors.forename: Denis
authors.initials: D
authors.lastname: Krausé
authors.forename: Jean-Pierre
authors.initials: JP
authors.lastname: Cercueil
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D006528:Carcinoma, Hepatocellular / Q000175:diagnosis*; D003287:Contrast Media / Q000008:administration & dosage*; D003911:Dextrans; D005260:Female; D052203:Ferrosoferric Oxide; D019786:Gadolinium DTPA / Q000008:administration & dosage*; D006801:Humans; D007501:Iron / Q000008:administration & dosage*; D008103:Liver Cirrhosis / Q000175:diagnosis; D008113:Liver Neoplasms / Q000175:diagnosis*; D008279:Magnetic Resonance Imaging / Q000379:methods*; D058185:Magnetite Nanoparticles; D008297:Male; D008875:Middle Aged; D010087:Oxides / Q000008:administration & dosage*; D011237:Predictive Value of Tests; D012189:Retrospective Studies
chemical_list: D003287:Contrast Media; D003911:Dextrans; D058185:Magnetite Nanoparticles; D010087:Oxides; C064925:gadodiamide; D007501:Iron; C065507:ferumoxides; D019786:Gadolinium DTPA; D052203:Ferrosoferric Oxide