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Abstract Details
Assessing locoregional treatment response to Hepatocellular Carcinoma: comparison of hepatobiliary contrast agents to extracellular contrast agents
Anum Aslam1, Amita Kamath2, Bradley Spieler3, Mark Maschiocchi4, Carl F Sabottke5, Victoria Chernyak6, Sara C Lewis7
Author information
1Department of Radiology, University of Michigan Health System, 1500 E. Medical Center Dr, Ann Arbor, MI, 48109-5030, USA. aanum@med.umich.edu.
2Department of Diagnostic, Molecular and Interventional Radiology, Icahn School of Medicine At Mount Sinai, New York, NY, USA.
3Department of Radiology, Louisiana State University Health Sciences Center, 1542 Tulane Avenue, Rm 343, New Orleans, LA, 70112, USA.
4Umass Memorial Medical Center- University Campus, 55 Lake Avenue North, Worcester, MA, 01655, USA.
5Department of Medical Imaging, University of Arizona College of Medicine, Tucson, AZ, USA.
6Department of Radiology and Urology, Albert Einstein College of Medicine, New York, 10467, USA.
7Department of Diagnostic, Molecular and Interventional Radiology, BioMedical Engineering and Imaging Institute, Icahn School of Medicine at Mount Sinai, New York, NY, USA.
Abstract
Cross-sectional imaging with contrast-enhanced magnetic resonance imaging (MRI) is routinely performed in patients with hepatocellular carcinoma (HCC) to assess tumor response to locoregional therapy (LRT). Current response assessment algorithms, such as the Liver Imaging Reporting and Data System (LI-RADS) treatment response algorithm (TRA), allow assessment using conventional gadolinium-based extracellular contrast agents (ECA) for accurate tumor response assessment following LRT. MRI with hepatobiliary agents (HBA) allows an acquisition of hepatobiliary phase (HBP), which is proven to increase sensitivity for detection of observations in at-risk patients, particularly for findings < 2 cm. The use of HBA is not yet incorporated into the TRA; however, it is increasingly used in clinical practice. Few published studies have evaluated the performance of LI-RADS TRA by applying ancillary features related to HBP that has resulted in category adjustment, enabling more sensitive and unequivocal diagnosis. This may help timely management of viable cases, without a significant loss of specificity in comparison with the ECA-based LI-RADS TRA assessment. In this review, we will describe and compare the imaging appearance of treated HCC on MRI using extracellular and hepatobiliary contrast agents and discuss emerging evidence and pitfalls in the assessment of tumor response following LRT with HBA.