Can Gadoxetic Acid-Enhanced MRI Improve Detection of Sub-centimeter HCC Recurrence?

Gadoxetic acid-enhanced magnetic resonance imaging (MRI) may facilitate earlier detection of hepatocellular recurrence (HCC), according to findings from a new study.

For the retrospective study, recently published in Insights into Imaging, researchers reviewed data from 153 patients (mean age of 55.3) with a total of 185 suspicious sub-centimeter hepatic lesions. Within two weeks after undergoing a hepatectomy, all patients had extracellular contrast agent-enhanced MRI (ECA-MRI) with gadobutrol (Gadavist, Bayer HeealthCare) as well as gadoxetic-acid enhanced MRI (EOB-MRI) with gadoxetate disodium (Primovist, Bayer HealthCare).

While both imaging approaches to identifying the typical vascular pattern for sub-centimeter recurrent HCC yielded sensitivity rates below 50 percent, a modified diagnosis algorithm for EOB-MRI yielded an 81.2 percent sensitivity rate and a 90.3 percent specificity rate in the 117-patient training set. The use of ECA-MRI’s modified diagnosis algorithm offered a 98.4 percent specificity but only a 42.5 percent sensitivity rate, according to the study authors.

In time-independent testing for 36 patients, the researchers noted a 37.5 percent higher sensitivity (79.2 percent) with EOB-MRI’s modified diagnosis algorithm in contrast to ECA-MRI (41.7 percent).

“EOB-MRI with a modified algorithm exhibited superior diagnostic performance for sub-centimeter recurrent HCC compared with ECA-MRI, providing a more sensitive and reliable imaging strategy for early recurrence identification,” noted lead study author Yuyao Xiao, MD, who is affiliated with the Shanghai Institute of Medical Imaging and the Department of Radiology at Zhongshan Hospital in Shanghai, China, and colleagues.

Noting that current LI-RADS guidelines only recommend non-peripheral washout assessment on the portal venous phase (PVP) for EOB-MRI, the study authors emphasized that evaluating washout in the transitional phase (TP) with EOB-MRI can yield dividends with sub-centimeter HCC detection.

“… Previous studies suggest that including TP in the washout assessment can improve sensitivity without compromising specificity, even in sub-centimeter HCC. In our study, EOB-MRI-based modified algorithm—the combination of T2WI mild-moderate hyperintensity, non-peripheral washout on PVP or TP and restricted diffusion—showed significantly improved sensitivity compared with the typical vascular pattern … while also maintaining high specificity,” added Xiao and colleagues.

(Editor’s note: For related content, see “Emerging MRI Scoring System May Help Predict Recurrent and Metastatic Hepatocellular Carcinoma,” “Could Contrast-Enhanced Ultrasound Offer Equivalency to MRI for Detecting Small HCC Nodules?” and “Multicenter Study Affirms Value of Updated AASLD Criteria for Surveillance for Hepatocellular Carcinoma.”)

Beyond the inherent limitations of a single-center retrospective trial, the authors cautioned that the cohort — drawn from a Chinese tertiary center with a majority of patients having HBV-related HCC — may thwart extrapolation of the study findings to broader populations.