title: Hepatocellular carcinoma detection: diagnostic performance of a simulated abbreviated MRI protocol combining diffusion-weighted and T1-weighted imaging at the delayed phase post gadoxetic acid.
abstract: The purpose of this study was to evaluate the diagnostic performance of a "simulated" abbreviated MRI (AMRI) protocol using diffusion-weighted imaging (DWI) and T1-weighted (T1w) imaging obtained at the hepatobiliary phase (HBP) post gadoxetic acid injection alone and in combination, compared to dynamic contrast-enhanced (CE)-T1w imaging for the detection of hepatocellular carcinoma (HCC).
  
  
  
  This was an IRB approved HIPAA compliant retrospective single institution study including patients with liver disease who underwent gadoxetic acid-enhanced MRI for HCC diagnosis. Three independent observers assessed 2 sets of images (full CE-set and AMRI including DWI+T1w-HBP). Diagnostic performance of T1w-HBP and DWI alone and in combination was compared to that of CE-set. All imaging sets included unenhanced T1w and T2w sequences. A preliminary analysis was performed to assess cost savings of AMRI protocol compared to a full MRI study.
  
  
  
  174 patients including 62 with 80 HCCs were assessed. Equivalent per-patient sensitivity and negative predictive value (NPV) were observed for DWI (85.5% and 92.2%, pooled data) and T1w-HBP (89.8% and 94.2%) (P = 0.1-0.7), while these were significantly lower for the full AMRI protocol (DWI+T1w-HBP, 80.6% and 80%, P = 0.02) when compared to CE-set (90.3% and 94.9%). Higher specificity and positive predictive value were observed for CE-set vs. AMRI (P = 0.02). The estimated cost reduction of AMRI versus full MRI ranged between 30.7 and 49.0%.
  
  
  
  AMRI using DWI and T1w-HBP has a clinically acceptable sensitivity and NPV for HCC detection. This could serve as the basis for a future study assessing AMRI for HCC screening and surveillance.
authors.affiliation: Translational and Molecular Imaging Institute, Icahn School of Medicine at Mount Sinai, 1470 Madison Avenue, New York, NY, 10029, USA.|Department of Radiology, Icahn School of Medicine at Mount Sinai, New York, NY, 10029, USA.
authors.forename: Cecilia
authors.initials: C
authors.lastname: Besa
authors.affiliation: Department of Radiology, Icahn School of Medicine at Mount Sinai, New York, NY, 10029, USA.
authors.forename: Sara
authors.initials: S
authors.lastname: Lewis
authors.affiliation: Institute for Technology Assessment, Department of Radiology, Massachusetts General Hospital, Boston, MA, USA.
authors.forename: Pari V
authors.initials: PV
authors.lastname: Pandharipande
authors.affiliation: Institute for Technology Assessment, Department of Radiology, Massachusetts General Hospital, Boston, MA, USA.
authors.forename: Jagpreet
authors.initials: J
authors.lastname: Chhatwal
authors.affiliation: Department of Radiology, Icahn School of Medicine at Mount Sinai, New York, NY, 10029, USA.
authors.forename: Amita
authors.initials: A
authors.lastname: Kamath
authors.affiliation: Department of Radiology, Icahn School of Medicine at Mount Sinai, New York, NY, 10029, USA.
authors.forename: Nancy
authors.initials: N
authors.lastname: Cooper
authors.affiliation: Translational and Molecular Imaging Institute, Icahn School of Medicine at Mount Sinai, 1470 Madison Avenue, New York, NY, 10029, USA.
authors.forename: Ashley
authors.initials: A
authors.lastname: Knight-Greenfield
authors.affiliation: Department of Radiology, New York University Langone Medical Center, New York, NY, USA.
authors.forename: James S
authors.initials: JS
authors.lastname: Babb
authors.affiliation: Division of Cancer Prevention and Control, Department of Oncological Sciences, Icahn School of Medicine at Mount Sinai, New York, NY, USA.
authors.forename: Paolo
authors.initials: P
authors.lastname: Boffetta
authors.affiliation: Department of Population Health Science and Policy, Icahn School of Medicine at Mount Sinai, New York, NY, USA.
authors.forename: Norma
authors.initials: N
authors.lastname: Padron
authors.affiliation: Liver Imaging Group, Department of Radiology, University of California, San Diego, CA, USA.
authors.forename: Claude B
authors.initials: CB
authors.lastname: Sirlin
authors.affiliation: Translational and Molecular Imaging Institute, Icahn School of Medicine at Mount Sinai, 1470 Madison Avenue, New York, NY, 10029, USA. bachir.taouli@mountsinai.org.|Department of Radiology, Icahn School of Medicine at Mount Sinai, New York, NY, 10029, USA. bachir.taouli@mountsinai.org.
authors.forename: Bachir
authors.initials: B
authors.lastname: Taouli
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D006528:Carcinoma, Hepatocellular / Q000000981:diagnostic imaging*; D003287:Contrast Media; D038524:Diffusion Magnetic Resonance Imaging; D005260:Female; D019786:Gadolinium DTPA; D006801:Humans; D008113:Liver Neoplasms / Q000000981:diagnostic imaging*; D008279:Magnetic Resonance Imaging / Q000379:methods*; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D012680:Sensitivity and Specificity
chemical_list: D003287:Contrast Media; C073590:gadolinium ethoxybenzyl DTPA; D019786:Gadolinium DTPA
keywords: Diffusion-weighted imaging; Gadoxetic acid; Hepatocellular carcinoma; MRI