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Double-Contrast MRI Helps Stage HCC in Cirrhosis

February 4, 2008
Written by: , Filed in: Abdominal Imaging
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The objective of a recent study was to determine if double-contrast MRI is accurate in staging hepatocellular carcinoma (HCC) in cirrhotic patients.

The study has concluded that double-contrast MRI is highly accurate in the staging of hepatocellular carcinoma in cirrhotic patients.

Participants
34 men and 14 women (median age, 54 years) with cirrhosis.

Methodology
MRI was performed on a 1.5-Tesla system approximately 30 to 60 minutes after completion of the superparamagnetic iron oxide (SPIO) infusion. Three-dimensional interpolated T1-weighted fat-saturated SPGR gadolinium-enhanced images were obtained during the hepatic arterial, portal venous, and equilibrium phases at 20, 60, and 120 seconds, respectively. The explanted livers were sectioned by a pathologist and examined for suspicious macroscopic nodules.

Each liver was given a pathologic tumor stage which served as the reference standard according to the American Liver Tumor Study Group staging classification.

A blinded retrospective review of the MRI images was performed by two abdominal MRI radiologists. The findings were converted into MRI tumor stage based on the size and number of lesions with positive ratings.

The SPIO-enhanced images characterized the lesions based on phagocytic function and were used to identify hypovascular lesions not apparent on the gadolinium-enhanced images. Gadolinium-enhanced dynamic images assessed the vascularity of the lesions.

Each radiologist reviewed the two image sets and scored the lesions on a scale of 1 (definitely not HCC) to 5 (definitely HCC). Following the blinded review, MRI images were re-reviewed together with the pathology reports.

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Results of the Study
23 patients had no HCC (stage T0) and 25 had HCC (stage T1 n=3; T2 n=18; T3 n=1; T4a n=1; T4b n=2). Double-contrast MRI had up to an 85% accuracy in staging HCC in cirrhotic patients. The “per patient” and “per lesion” sensitivities in the diagnosis of HCC were approximately 96% and 89%, respectively.

Reviewer’s Comments
The results of this study are very promising in demonstrating the potential utility of the double-contrast MRI technique in the staging evaluation of HCC in cirrhotic patients. The combined properties of gadolinium chelates and SPIO agents in the same examination can afford a more comprehensive characterization of liver lesions and can more accurately assess the tumor burden in this patient population. This would help prioritize patients and more accurately give highest consideration to those who meet the desired staging criteria for transplantation.

One limitation reported in this study was that a direct comparison between double- and single-contrast MRI staging of HCC was not performed.

Author: John C. Sabatino, MD
Reference:
Hanna RF, Kased N, et al. Double-Contrast MRI for Accurate Staging of Hepatocellular Carcinoma in Patients With Cirrhosis.
AJR Am J Roentgenol; 2008; 190 (January): 47-57

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