Comparison of international guidelines for diagnosis of hepatocellular carcinoma and implications for transplant allocation in liver transplantation candidates with gadoxetic acid enhanced liver MRI versus contrast enhanced CT: a prospective study with liver explant histopathological correlation
Abstract Objectives To compare the diagnostic performance of international hepatocellular carcinoma (HCC) guidelines with gadoxetic acid-enhanced MRI (EOB-MRI) and contrast-enhanced Computed tomography (CECT) and their impact on liver transplant (LT) allocation in cirrhotic patients with explant his...
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| Format: | Article |
| Language: | English |
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BMC
2022-10-01
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| Series: | Cancer Imaging |
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| Online Access: | https://doi.org/10.1186/s40644-022-00497-9 |
| _version_ | 1828106094456602624 |
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| author | Devang Odedra Ali Babaei Jandaghi Rajesh Bhayana Khaled Y. Elbanna Osvaldo Espin-Garcia Sandra E. Fischer Anand Ghanekar Gonzalo Sapisochin Kartik S. Jhaveri |
| author_facet | Devang Odedra Ali Babaei Jandaghi Rajesh Bhayana Khaled Y. Elbanna Osvaldo Espin-Garcia Sandra E. Fischer Anand Ghanekar Gonzalo Sapisochin Kartik S. Jhaveri |
| author_sort | Devang Odedra |
| collection | DOAJ |
| description | Abstract Objectives To compare the diagnostic performance of international hepatocellular carcinoma (HCC) guidelines with gadoxetic acid-enhanced MRI (EOB-MRI) and contrast-enhanced Computed tomography (CECT) and their impact on liver transplant (LT) allocation in cirrhotic patients with explant histopathology correlation. Methods In this prospective single-centre ethics-approved study, 101 cirrhotic patients were consecutively enrolled with informed consent from the pre-LT clinic. They underwent CECT and EOB-MRI alternately at three monthly intervals until LT or removal from LT list. Two abdominal radiologists, blinded to explant histopathology, independently recorded liver lesions visible on CECT and EOB-MRI. Imaging-based HCC scores were assigned to non-treated liver lesions utilizing Liver Imaging Reporting and Data System (LI-RADS), European Association for the Study of the Liver (EASL), Asian-Pacific Association for the Study of the Liver (APASL) and Korean Liver Cancer Association-National Cancer Center (KLCA) guidelines. Liver explant histopathology was the reference standard. Simulated LT eligibility was assessed as per Milan criteria (MC) in reference to explant histopathology. Results One hundred and three non-treated HCC and 12 non-HCC malignancy were identified at explant histopathology in 34 patients (29 men, 5 women, age 55–73 years). Higher HCC sensitivities of statistical significance were observed with EOB-MRI for LI-RADS 4 + 5, APASL and KLCA compared to LI-RADS 5 and EASL with greatest sensitivity obtained for LIRADS 4 + 5 lesions. HCC sensitivities by all guidelines with both EOB-MRI and CECT were significantly lower if all histopathology-detected HCCs were included in the analysis, compared to imaging-visible lesions only. A significantly greater variation in HCC sensitivity was noted across the guidelines with EOB-MRI compared to CECT. No significant differences in simulated LT eligibility based on MC were observed across the HCC scoring guidelines with EOB-MRI or CECT. Conclusion HCC sensitivities are variable depending on scoring guideline, lesion size and imaging modality utilised. Prior studies that included only lesions visible on pre-operative imaging overestimate the diagnostic performance of HCC scoring guidelines. Per-lesion differences in HCC diagnosis across these guidelines did not impact patient-level LT eligibility based on MC. |
| first_indexed | 2024-04-11T10:11:59Z |
| format | Article |
| id | doaj.art-958ed5f871e746dabf42902045f46df0 |
| institution | Directory Open Access Journal |
| issn | 1470-7330 |
| language | English |
| last_indexed | 2024-04-11T10:11:59Z |
| publishDate | 2022-10-01 |
| publisher | BMC |
| record_format | Article |
| series | Cancer Imaging |
| spelling | doaj.art-958ed5f871e746dabf42902045f46df02022-12-22T04:30:05ZengBMCCancer Imaging1470-73302022-10-0122111110.1186/s40644-022-00497-9Comparison of international guidelines for diagnosis of hepatocellular carcinoma and implications for transplant allocation in liver transplantation candidates with gadoxetic acid enhanced liver MRI versus contrast enhanced CT: a prospective study with liver explant histopathological correlationDevang Odedra0Ali Babaei Jandaghi1Rajesh Bhayana2Khaled Y. Elbanna3Osvaldo Espin-Garcia4Sandra E. Fischer5Anand Ghanekar6Gonzalo Sapisochin7Kartik S. Jhaveri8Department of Medical Imaging, University Health Network Mount Sinai Hospital and Women’s College HospitalDepartment of Medical Imaging, University Health Network Mount Sinai Hospital and Women’s College HospitalDepartment of Medical Imaging, University Health Network Mount Sinai Hospital and Women’s College Hospital University of TorontoDepartment of Medical Imaging, University Health Network Mount Sinai Hospital and Women’s College Hospital University of TorontoDepartment of Biostatistics, Princess Margaret Cancer Centre, University Health NetworkDepartment of Laboratory Medicine and Pathobiology, University of TorontoDepartment of Surgery, University Health Network and Toronto General Hospital University of TorontoDepartment of Surgery, University Health Network and Toronto General Hospital University of TorontoDepartment of Medical Imaging, University Health Network Mount Sinai Hospital and Women’s College Hospital University of TorontoAbstract Objectives To compare the diagnostic performance of international hepatocellular carcinoma (HCC) guidelines with gadoxetic acid-enhanced MRI (EOB-MRI) and contrast-enhanced Computed tomography (CECT) and their impact on liver transplant (LT) allocation in cirrhotic patients with explant histopathology correlation. Methods In this prospective single-centre ethics-approved study, 101 cirrhotic patients were consecutively enrolled with informed consent from the pre-LT clinic. They underwent CECT and EOB-MRI alternately at three monthly intervals until LT or removal from LT list. Two abdominal radiologists, blinded to explant histopathology, independently recorded liver lesions visible on CECT and EOB-MRI. Imaging-based HCC scores were assigned to non-treated liver lesions utilizing Liver Imaging Reporting and Data System (LI-RADS), European Association for the Study of the Liver (EASL), Asian-Pacific Association for the Study of the Liver (APASL) and Korean Liver Cancer Association-National Cancer Center (KLCA) guidelines. Liver explant histopathology was the reference standard. Simulated LT eligibility was assessed as per Milan criteria (MC) in reference to explant histopathology. Results One hundred and three non-treated HCC and 12 non-HCC malignancy were identified at explant histopathology in 34 patients (29 men, 5 women, age 55–73 years). Higher HCC sensitivities of statistical significance were observed with EOB-MRI for LI-RADS 4 + 5, APASL and KLCA compared to LI-RADS 5 and EASL with greatest sensitivity obtained for LIRADS 4 + 5 lesions. HCC sensitivities by all guidelines with both EOB-MRI and CECT were significantly lower if all histopathology-detected HCCs were included in the analysis, compared to imaging-visible lesions only. A significantly greater variation in HCC sensitivity was noted across the guidelines with EOB-MRI compared to CECT. No significant differences in simulated LT eligibility based on MC were observed across the HCC scoring guidelines with EOB-MRI or CECT. Conclusion HCC sensitivities are variable depending on scoring guideline, lesion size and imaging modality utilised. Prior studies that included only lesions visible on pre-operative imaging overestimate the diagnostic performance of HCC scoring guidelines. Per-lesion differences in HCC diagnosis across these guidelines did not impact patient-level LT eligibility based on MC.https://doi.org/10.1186/s40644-022-00497-9Hepatocellular carcinomaGadoxetic acid enhanced magnetic resonance imagingLiver imaging and data reporting systemLiver transplantationMilan criteria |
| spellingShingle | Devang Odedra Ali Babaei Jandaghi Rajesh Bhayana Khaled Y. Elbanna Osvaldo Espin-Garcia Sandra E. Fischer Anand Ghanekar Gonzalo Sapisochin Kartik S. Jhaveri Comparison of international guidelines for diagnosis of hepatocellular carcinoma and implications for transplant allocation in liver transplantation candidates with gadoxetic acid enhanced liver MRI versus contrast enhanced CT: a prospective study with liver explant histopathological correlation Cancer Imaging Hepatocellular carcinoma Gadoxetic acid enhanced magnetic resonance imaging Liver imaging and data reporting system Liver transplantation Milan criteria |
| title | Comparison of international guidelines for diagnosis of hepatocellular carcinoma and implications for transplant allocation in liver transplantation candidates with gadoxetic acid enhanced liver MRI versus contrast enhanced CT: a prospective study with liver explant histopathological correlation |
| title_full | Comparison of international guidelines for diagnosis of hepatocellular carcinoma and implications for transplant allocation in liver transplantation candidates with gadoxetic acid enhanced liver MRI versus contrast enhanced CT: a prospective study with liver explant histopathological correlation |
| title_fullStr | Comparison of international guidelines for diagnosis of hepatocellular carcinoma and implications for transplant allocation in liver transplantation candidates with gadoxetic acid enhanced liver MRI versus contrast enhanced CT: a prospective study with liver explant histopathological correlation |
| title_full_unstemmed | Comparison of international guidelines for diagnosis of hepatocellular carcinoma and implications for transplant allocation in liver transplantation candidates with gadoxetic acid enhanced liver MRI versus contrast enhanced CT: a prospective study with liver explant histopathological correlation |
| title_short | Comparison of international guidelines for diagnosis of hepatocellular carcinoma and implications for transplant allocation in liver transplantation candidates with gadoxetic acid enhanced liver MRI versus contrast enhanced CT: a prospective study with liver explant histopathological correlation |
| title_sort | comparison of international guidelines for diagnosis of hepatocellular carcinoma and implications for transplant allocation in liver transplantation candidates with gadoxetic acid enhanced liver mri versus contrast enhanced ct a prospective study with liver explant histopathological correlation |
| topic | Hepatocellular carcinoma Gadoxetic acid enhanced magnetic resonance imaging Liver imaging and data reporting system Liver transplantation Milan criteria |
| url | https://doi.org/10.1186/s40644-022-00497-9 |
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