Comparison of gadoxetic acid versus gadopentetate dimeglumine for the detection of hepatocellular carcinoma at 1.5\u2009T using the liver imaging reporting and data system (LI-RADS v.2017)

Ying Ding,Ren-Chen Li,Sheng-Xiang Rao,Wen-Tao Wang,Mengsu Zeng,Cai-Zhong Chen

doi:10.1186/s40644-018-0183-3

Abstract

PurposeThe goal of this study was to investigate the Liver Imaging Reporting and Data System (LI-RADS) v.2017 for the categorization of hepatocellular carcinomas (HCCs) with gadoxetic acid compared with gadopentetate dimeglumine-enhanced 1.5-T magnetic resonance imaging (MRI).Material and methodsWe included 141 high-risk patients with 145 pathologically-confirmed HCCs who first underwent gadopentetate dimeglumine-enhanced 1.5-T followed by gadoxetic acid-enhanced 1.5-T MRI. Two independent radiologists evaluated the presence or absence of major HCC features and assigned LI-RADS categories after considering ancillary features on both MRIs. Finally, the sensitivity of LI-RADS category 5 (LR-5) and the frequencies of major HCC features were compared between gadoxetic acid- and gadopentetate dimeglumine-enhanced 1.5-T MRI using the Wilcoxon test.ResultsThe sensitivity of LR-5 for diagnosing HCCs was significantly different between gadoxetic acid- and gadopentetate dimeglumine-enhanced MRI (73.8% [107/145] vs 26.2% [38/145], P < 0.001; 71% [103/145] vs 29% [42/145], P < 0.001 for reviewers 1 and 2, respectively). Among the major HCC LI-RADS features, capsule appearance was less frequently demonstrated on gadoxetic acid-enhanced MRI than on gadopentetate dimeglumine-enhanced MRI (3.4% [5/145] vs 5.5% [8/145], P = 0.793; 4.1% [6/145] vs 5.5% [8/145], P = 0.87 for reviewers 1 and 2, respectively), and the frequency of arterial hyperenhancement was not significantly different between gadoxetic acid and gadopentetate dimeglumine (89% [129/145] vs 89% [129/145], P = 1.000). In addition, the frequency of a washout appearance was less in the transitional phase (TP) than in the portal venous phase (PVP) on gadoxetic acid-enhanced MRI (43% [46/107] vs 57% [61/107], P = 0.367).ConclusionGadoxetic acid-enhanced MRI showed a comparable sensitivity to gadopentetate dimeglumine-enhanced MRI for the diagnosis of HCCs, and LI-RADS category 4 (LR-4) hepatic nodules were upgraded to LR-5 when taking into account the major features according to LI-RADS v.2017.

Highlights

Hepatocellular carcinoma (HCC) is the fifth most common malignant tumor and the third most common cause of global cancer death over the world [1]
The sensitivity of LI-RADS category 5 (LR-5) for diagnosing HCCs was significantly different between gadoxetic acid- and gadopentetate dimeglumine-enhanced magnetic resonance imaging (MRI) (73.8% [107/145] vs 26.2% [38/145], P < 0.001; 71% [103/145] vs 29% [42/145], P < 0.001 for reviewers 1 and 2, respectively)
Gadoxetic acid-enhanced MRI showed a comparable sensitivity to gadopentetate dimeglumine-enhanced MRI for the diagnosis of HCCs, and Liver Imaging Reporting and Data System (LI-RADS) category 4 (LR-4) hepatic nodules were upgraded to LR-5 when taking into account the major features according to LI-RADS v

Summary

Introduction

Hepatocellular carcinoma (HCC) is the fifth most common malignant tumor and the third most common cause of global cancer death over the world [1]. The American Association for the Study of Liver Diseases (AASLD) and the European Association for the Study of the Liver (EASL) report the typical vascular enhancement pattern of HCC, and the Barcelona Clinical Liver Cancer (BCLC) staging system stipulate the choice of the treatment for HCC [4,5,6]. To achieve a better standardized imaging interpretation of focal liver observations in patients at high risk for HCC, the Liver Imaging Reporting and Data System (LI-RADS) was created and has received more attention recently. LI-RADS provides detailed descriptions and supported illustrations of all the defined imaging features. It is used for more nuanced and personalized clinical decision-making and provides separate categories that can be assigned to suspected non-HCC malignancies or macrovascular invasive HCC. The latest version of LI-RADS is the 2017 version, which is available online with extensive supporting information (https://www.acr.org/Clinical-Resources/Reporting-and-DataSystems/LI-RADS) [8, 9]

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