Abbreviated magnetic resonance imaging vs ultrasound for surveillance of hepatocellular carcinoma in high-risk patients
Hyo Jung Park
Department of Radiology and Research Institute of Radiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
Search for more papers by this authorCorresponding Author
So Yeon Kim
Department of Radiology and Research Institute of Radiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
Liver Cancer Center, Asan Medical Center, Seoul, Republic of Korea
Correspondence
So Yeon Kim, Department of Radiology, Asan Medical Center, University of Ulsan College of Medicine, 88 Olympic-ro 43-gil, Songpa-gu, Seoul 05505, Republic of Korea.
Email: [email protected], [email protected]
Amit G. Singal, Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas, TX, USA.
Email: [email protected]
Young-Suk Lim, Department of Gastroenterology, Liver Center, Asan Medical Center, University of Ulsan College of Medicine, 88 Olympic-ro 43-gil, Songpa-gu, Seoul 05505, Republic of Korea.
Email: [email protected]
Search for more papers by this authorCorresponding Author
Amit G. Singal
Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas, Texas, USA
Correspondence
So Yeon Kim, Department of Radiology, Asan Medical Center, University of Ulsan College of Medicine, 88 Olympic-ro 43-gil, Songpa-gu, Seoul 05505, Republic of Korea.
Email: [email protected], [email protected]
Amit G. Singal, Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas, TX, USA.
Email: [email protected]
Young-Suk Lim, Department of Gastroenterology, Liver Center, Asan Medical Center, University of Ulsan College of Medicine, 88 Olympic-ro 43-gil, Songpa-gu, Seoul 05505, Republic of Korea.
Email: [email protected]
Search for more papers by this authorSo Jung Lee
Department of Radiology and Research Institute of Radiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
Liver Cancer Center, Asan Medical Center, Seoul, Republic of Korea
Search for more papers by this authorHyung Jin Won
Department of Radiology and Research Institute of Radiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
Liver Cancer Center, Asan Medical Center, Seoul, Republic of Korea
Search for more papers by this authorJae Ho Byun
Department of Radiology and Research Institute of Radiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
Liver Cancer Center, Asan Medical Center, Seoul, Republic of Korea
Search for more papers by this authorSang Hyun Choi
Department of Radiology and Research Institute of Radiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
Liver Cancer Center, Asan Medical Center, Seoul, Republic of Korea
Search for more papers by this authorTakeshi Yokoo
Department of Radiology, University of Texas Southwestern Medical Center, Dallas, Texas, USA
Search for more papers by this authorMin-Ju Kim
Department of Clinical Epidemiology and Biostatistics, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
Search for more papers by this authorCorresponding Author
Young-Suk Lim
Liver Cancer Center, Asan Medical Center, Seoul, Republic of Korea
Department of Gastroenterology, Liver Center, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
Correspondence
So Yeon Kim, Department of Radiology, Asan Medical Center, University of Ulsan College of Medicine, 88 Olympic-ro 43-gil, Songpa-gu, Seoul 05505, Republic of Korea.
Email: [email protected], [email protected]
Amit G. Singal, Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas, TX, USA.
Email: [email protected]
Young-Suk Lim, Department of Gastroenterology, Liver Center, Asan Medical Center, University of Ulsan College of Medicine, 88 Olympic-ro 43-gil, Songpa-gu, Seoul 05505, Republic of Korea.
Email: [email protected]
Search for more papers by this authorHyo Jung Park
Department of Radiology and Research Institute of Radiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
Search for more papers by this authorCorresponding Author
So Yeon Kim
Department of Radiology and Research Institute of Radiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
Liver Cancer Center, Asan Medical Center, Seoul, Republic of Korea
Correspondence
So Yeon Kim, Department of Radiology, Asan Medical Center, University of Ulsan College of Medicine, 88 Olympic-ro 43-gil, Songpa-gu, Seoul 05505, Republic of Korea.
Email: [email protected], [email protected]
Amit G. Singal, Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas, TX, USA.
Email: [email protected]
Young-Suk Lim, Department of Gastroenterology, Liver Center, Asan Medical Center, University of Ulsan College of Medicine, 88 Olympic-ro 43-gil, Songpa-gu, Seoul 05505, Republic of Korea.
Email: [email protected]
Search for more papers by this authorCorresponding Author
Amit G. Singal
Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas, Texas, USA
Correspondence
So Yeon Kim, Department of Radiology, Asan Medical Center, University of Ulsan College of Medicine, 88 Olympic-ro 43-gil, Songpa-gu, Seoul 05505, Republic of Korea.
Email: [email protected], [email protected]
Amit G. Singal, Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas, TX, USA.
Email: [email protected]
Young-Suk Lim, Department of Gastroenterology, Liver Center, Asan Medical Center, University of Ulsan College of Medicine, 88 Olympic-ro 43-gil, Songpa-gu, Seoul 05505, Republic of Korea.
Email: [email protected]
Search for more papers by this authorSo Jung Lee
Department of Radiology and Research Institute of Radiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
Liver Cancer Center, Asan Medical Center, Seoul, Republic of Korea
Search for more papers by this authorHyung Jin Won
Department of Radiology and Research Institute of Radiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
Liver Cancer Center, Asan Medical Center, Seoul, Republic of Korea
Search for more papers by this authorJae Ho Byun
Department of Radiology and Research Institute of Radiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
Liver Cancer Center, Asan Medical Center, Seoul, Republic of Korea
Search for more papers by this authorSang Hyun Choi
Department of Radiology and Research Institute of Radiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
Liver Cancer Center, Asan Medical Center, Seoul, Republic of Korea
Search for more papers by this authorTakeshi Yokoo
Department of Radiology, University of Texas Southwestern Medical Center, Dallas, Texas, USA
Search for more papers by this authorMin-Ju Kim
Department of Clinical Epidemiology and Biostatistics, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
Search for more papers by this authorCorresponding Author
Young-Suk Lim
Liver Cancer Center, Asan Medical Center, Seoul, Republic of Korea
Department of Gastroenterology, Liver Center, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
Correspondence
So Yeon Kim, Department of Radiology, Asan Medical Center, University of Ulsan College of Medicine, 88 Olympic-ro 43-gil, Songpa-gu, Seoul 05505, Republic of Korea.
Email: [email protected], [email protected]
Amit G. Singal, Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas, TX, USA.
Email: [email protected]
Young-Suk Lim, Department of Gastroenterology, Liver Center, Asan Medical Center, University of Ulsan College of Medicine, 88 Olympic-ro 43-gil, Songpa-gu, Seoul 05505, Republic of Korea.
Email: [email protected]
Search for more papers by this authorS.Y.K., A.S., and Y.S.L. contributed equally to this work as co-corresponding authors.
Handling Editor: Luca Valenti
Funding information
This work was supported by a grant from the National Institute of Health (U01 CA230694 to A.S.). The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institute of Health.
Abstract
Background & Aims
We aimed to compare the performance of gadoxetic acid-enhanced abbreviated MRI (AMRI)-based surveillance and ultrasound-only surveillance in high-risk patients for hepatocellular carcinoma (HCC).
Methods
Prospectively recruited high-risk patients (>5% annual risk of HCC) who underwent one to three rounds of complete gadoxetic acid-enhanced MRI (CMRI) and ultrasound at 6-months intervals were retrospectively analysed. AMRI consisted of diffusion-weighted, T2-weighted, and hepatobiliary phase imaging. The sensitivity, specificity, and accuracy of CMRI followed by AMRI (CAA), AMRI-only (AAA), and ultrasound-only (US) were compared using generalized estimating equations. Image quality was assessed.
Results
In 382 patients, HCC was diagnosed in 43 (11.3%), including 42 with early-stage HCCs. The sensitivities of CAA (90.7%, 39/43) and AAA (86.0%, 37/43) were higher than US (27.9% [12/43]; P < 0.001), whereas the sensitivities of the two MRI approaches did not significantly differ (P = 0.56). The specificity of CAA (97.1%, 983/1012) was higher than AAA (95.6% [967/1012]; P = 0.01) and not significantly different from US (96.3% [975/1012]; P = 0.59). The CAA approach had the best accuracy of 96.9% (1022/1055), higher than the AAA approach (95.2% [1004/1055]; P = 0.01) and the US approach (93.6% [987/1055]; P = 0.01). Image quality was inadequate in 33.7% (356/1055) of US examinations but in only 10.0% (105/1055) of the AAA and 11.1% (117/1055) of the CAA approach.
Conclusions
In high-risk patients, AMRI-based surveillance approaches had higher sensitivities than ultrasound-only surveillance for early-stage HCC. A sequential MRI approach of CMRI followed by AMRIs showed superior accuracy than the AMRI-only or ultrasound-only approach.
CONFLICT OF INTEREST
Dr. Amit G Singal has served as a consultant for Bayer, Wako Diagnostics, Glycotest, Exact Sciences, Roche, and TARGET Pharmasolutions. Dr. Sang Hyun Choi received grants from Bayer Healthcare outside the study. None of the other authors declare conflicts of interest that pertain to this work.
Open Research
DATA AVAILABILITY STATEMENT
Data are available upon reasonable request due to privacy.
Supporting Information
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Please note: The publisher is not responsible for the content or functionality of any supporting information supplied by the authors. Any queries (other than missing content) should be directed to the corresponding author for the article.
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