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Ricke J, Steffen IG, Bargellini I, Berg T, Bilbao Jaureguizar JI, Gebauer B, Iezzi R, Loewe C, Karçaaltincaba M, Pech M, Sengel C, van Delden O, Vandecaveye V, Zech CJ, Seidensticker M. Gadoxetic acid-based hepatobiliary MRI in hepatocellular carcinoma. JHEP Rep 2020; 2:100173. [PMID: 33103093 PMCID: PMC7578758 DOI: 10.1016/j.jhepr.2020.100173] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/12/2020] [Revised: 08/06/2020] [Accepted: 08/10/2020] [Indexed: 12/18/2022]
Abstract
Background & Aims SORAMIC is a prospective phase II randomised controlled trial in hepatocellular carcinoma (HCC). It consists of 3 parts: a diagnostic study and 2 therapeutic studies with either curative ablation or palliative Yttrium-90 radioembolisation combined with sorafenib. We report the diagnostic cohort study aimed to determine the accuracy of gadoxetic acid-enhanced magnetic resonance imaging (MRI), including hepatobiliary phase (HBP) imaging features compared with contrast-enhanced computed tomography (CT). The primary objective was the accuracy of treatment decisions stratifying patients for curative or palliative (non-ablation) treatment. Methods Patients with clinically suspected HCC underwent gadoxetic acid-enhanced MRI (HBP MRI, including dynamic MRI) and contrast-enhanced CT. Blinded read of the image data was performed by 2 reader groups (radiologists, R1 and R2). A truth panel with access to all clinical data and follow-up imaging served as reference. Imaging criteria for curative ablation were defined as up to 4 lesions <5 cm and absence of macrovascular invasion. The primary endpoint was non-inferiority of HBP MRI vs. CT in a first step and superiority in a second step. Results The intent-to-treat population comprised 538 patients. Treatment decisions matched the truth panel assessment in 83.3% and 81.2% for HBP MRI (R1 and R2), and 73.4% and 70.8% for CT. Non-inferiority and superiority (second step) of HBP MRI vs. CT were demonstrated (odds ratio 1.14 [1.09–1.19]). HBP MRI identified patients with >4 lesions significantly more frequently than CT. Conclusions In HCC, HBP MRI provided a more accurate decision than CT for a curative vs. palliative treatment strategy. Lay summary Patients with hepatocellular carcinoma are allocated to curative or palliative treatment according to the stage of their disease. Hepatobiliary imaging using gadoxetic acid-enhanced MRI is more accurate than CT for treatment decision-making. Comparison of gadoxetic acid-enhanced MRI vs. contrast-enhanced multi-slice CT to stratify patients with suspected HCC. Clinical decision-making was shown to be significantly more accurate with gadoxetic acid-enhanced hepatobiliary MRI than CT. To the best of our knowledge, this is the first study linking a clinical decision endpoint to hepatobiliary MRI criteria for HCC diagnosis. The results of our international multicentre trial could guide recommendations on the diagnostic management of HCC.
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Key Words
- APASL, Asian Pacific Association for the Study of the Liver
- BCLC, Barcelona Clinic Liver Cancer
- CT, computed tomography
- DWI, diffusion-weighted imaging
- GEE, generalised estimating equation
- GRE, gradient echo
- Gadoxetic acid
- HBP, hepatobiliary phase
- HCC, hepatocellular carcinoma
- HGDN, high-grade dysplastic nodule
- Hepatocellular carcinoma
- ITT, intent to treat
- MRI, magnetic resonance imaging
- Magnetic resonance imaging
- OR, odds ratio
- PP, per protocol
- RFA, radio-frequency ablation
- SORAMIC trial
- SORAMIC, Sorafenib and Micro-Therapy Guided by Gadolinium-EOB-DTPA-Enhanced MRI
- TSE, turbo spin echo
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Affiliation(s)
- Jens Ricke
- Department of Radiology, Ludwig-Maximilians-University Munich, Munich, Germany
| | - Ingo G Steffen
- Department of Radiology, Ludwig-Maximilians-University Munich, Munich, Germany
| | - Irene Bargellini
- Department of Interventional Radiology, Pisa University Hospital, Pisa, Italy
| | - Thomas Berg
- Klinik und Poliklinik für Gastroenterologie, Sektion Hepatologie, Universitätsklinikum Leipzig AöR, Leipzig, Germany
| | | | - Bernhard Gebauer
- Department of Radiology, Charité-Universitätsmedizin Berlin, Berlin, Germany
| | - Roberto Iezzi
- Dipartimento di Diagnostica per Immagini, Radioterapia Oncologica ed Ematologia, Fondazione Policlinico Universitario A. Gemelli IRCCS, UOC di Radiologia, Rome, Italy
| | - Christian Loewe
- Section of Cardiovascular and Interventional Radiology, Department of Bioimaging and Image-Guided Therapy, Medical University of Vienna, Vienna, Austria
| | | | - Maciej Pech
- Department of Radiology and Nuclear Medicine, University of Magdeburg, Magdeburg, Germany
| | - Christian Sengel
- Radiologie interventionnelle vasculaire et percutanée, CHU de Grenoble, Grenoble, France
| | - Otto van Delden
- Department of Radiology and Nuclear Medicine, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
| | | | - Christoph J Zech
- Radiology and Nuclear Medicine, University Hospital Basel, University of Basel, Basel, Switzerland
| | - Max Seidensticker
- Department of Radiology, Ludwig-Maximilians-University Munich, Munich, Germany
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Abstract
Present article is a review of radiological features of hepatocellular carcinoma on various imaging modalities. With the advancement in imaging techniques, biopsy is rarely needed for diagnosis of hepatocellular carcinoma (HCC), unlike other malignancies. Imaging is useful not only for diagnosis but also for surveillance, therapy and assessing response to treatment. The classical and the atypical radiological features of HCC have been described.
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Key Words
- A-P, arterio-portal
- CT, computerized tomography
- CTAP, CT during arterial portography
- CTHA, computerized tomography hepatic angiography
- GRE, gradient echo
- Gd-BOPTA, gadopentetate dimeglumine
- Gd-EOB, gadolinium ethoxybenzyl
- Gd-EOB-DTPA, gadolinium ethoxybenzyl diethylenetriamine pentaacetic acid
- HCC, hepatocellular carcinoma
- LI-RADS, Liver Imaging Reporting and Data System
- MDCT, multidetector CT
- MRI, magnetic resonance imaging
- SPIO, superparamagnetic iron oxide
- T1W, T1 weighted
- T2W, T2 weighted
- TACE, trans-arterial chemo-embolization
- TE, time to echo
- THAD, transient hepatic attenuation differentiation
- THID, transient hepatic intensity differentiation
- cirrhosis
- hepatocellular carcinoma
- liver cancer
- ultrasound
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Affiliation(s)
- Samir Shah
- Address for correspondence: Samir Shah, Institute of Liver Diseases, HPB Surgery and Liver Transplant, Global Hospitals, Mumbai, Maharashtra, India. Tel.: +91 22 67670205, +91 9059834047.
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