Abstract
Background: Liver Imaging Reporting and Data Systems (LI-RADS) Treatment Response Algorithm (TRA) was created to provide a standardized assessment of hepatocellular carcinoma (HCC) following loco regional therapy. The aim of this study was to compare sensitivity of standard MRI protocol versus abbreviated protocol (only T1-Weigthed fat suppressed (FS) sequences pre- and post-contrast phase) in the detection of ablated area according to LI-RADS Treatment Response (LR-TR) categories. Methods: From January 2015 to June 2020, we selected 64 patients with HCC, who underwent Radiofrequency ablation (RFA) or Microwave ablation (MWA) treatment. According to inclusion criteria, 136 pathologically proven treated HCC (median 2, range 1–3 per patient; mean size 20.0 mm; range 15–30 mm) in 58 patients (26 women, 32 men; median age, 74 years; range, 62–83 years) comprised our study population. For each ablated area, abbreviated protocol, and standard Magnetic Resonance Imaging (MRI) studies were independently and blindly assessed in random order within and between three expert radiologists. Each radiologist assessed the ablated area by using the following categories: “LR-TR Non-viable” = 1; “LR-TR Equivocal” = 2 and “LR-TR Viable” = 0. Results: According to the concordance between MRI and Contrast enhancement ultrasound (CEUS) among 136 treated HCCs, 115 lesions were assessed as non-viable or totally ablate and 21 as viable or partially ablate. The accuracy for standard MRI protocol and abbreviated MRI protocol for predicting pathologic tumor viability of a consensus reading was 98.6% (sensitivity = 100%; specificity = 98.3%; positive predictive value = 91.3% and negative predictive value = 100%). No differences were found in sensitivity or specificity between standard MRI LR-TR viable and abbreviated MRI LR-TR viable categories (p value > 0.05 at McNemar test). Conclusion: The abbreviated dynamic protocol showed similar diagnostic accuracy to conventional MRI study in the assessment of treated HCCs, with a reduction of the acquisition study time of 30% respect to conventional MRI.
Highlights
Ablation treatment is a minimally invasive tool that is commonly employed in the hepatic primary or secondary liver tumors [1,2,3,4,5]
The inclusion criteria for the study population were as follows: (a) patients with radiological diagnosis of hepatocellular carcinoma (HCC); (b) patients who had subjects to Magnetic Resonance Imaging (MRI) study within one month before treatment and who underwent MRI post 1 month after treatment; (c) patients who had less than a one-month between radiological and pathological diagnosis and (d) patients with pathologically proven HCC
According to the reference standard among 136 HCCs treated with RF or Microwave ablation (MWA), 115 lesions were assessed as non-viable or totally ablate and 21 as viable or partially ablate
Summary
Ablation treatment is a minimally invasive tool that is commonly employed in the hepatic primary or secondary liver tumors [1,2,3,4,5]. This treatment is considered a possible first-line tool in small hepatocarcinoma (HCC) or the best therapeutic choice for nonsurgical patients with early stage HCC [1]. For each ablated area, abbreviated protocol, and standard Magnetic Resonance Imaging (MRI) studies were independently and blindly assessed in random order within and between three expert radiologists.
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