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Gadolinium-Enhanced MRI for Tumor Surveillance Before Liver Transplantation: Center-Based Experience

¹ Department of Radiology, Emory University Hospital, Emory Clinic, Bldg. A, Ste. AT-627, 1365 Clifton Rd., Atlanta, GA 30322.
² Department of Pathology, Emory University Hospital, Atlanta, GA.
³ Department of Surgery, Division of Transplantation, Emory University Hospital, Atlanta, GA.
⁴ Division of Digestive Diseases, Liver Transplant Center, Emory University Hospital, Atlanta, GA.
⁵ Department Gastroenterology, Emory University Hospital, Atlanta, GA.

OBJECTIVE. The purpose of this study was to evaluate prospectively acquired institutional results to determine the accuracy of gadolinium-enhanced MRI in liver tumor surveillance before transplantation.

SUBJECTS AND METHODS. One hundred fifteen patients underwent MRI of the abdomen within 90 days before liver transplantation. Images were acquired with gadolinium-enhanced 3D gradient-echo sequences in the arterial, venous, and delayed phases. Detection of hepatocellular carcinoma (HCC) was based on the imaging criteria arterial phase enhancement, delayed phase hypointensity, and development of an enhancing outer margin capsule. Imaging findings were compared with findings at histopathologic evaluation of the explanted liver.

RESULTS. Thirty-six HCCs in 27 patients were detected at histopathologic evaluation. Patient-based analysis showed the sensitivity of MRI was 88.9% (24/27); specificity, 97.7% (false-positive findings in two patients); and accuracy, 95.7%. MRI depicted 28 of 36 HCCs, resulting in a lesion-based sensitivity of 77.8%. Although all 18 HCCs 2 cm or larger were depicted with MRI, only 10 of 18 HCCs smaller than 2 cm were correctly diagnosed. However, two HCCs measuring smaller than 2 cm at pathologic examination were rated as dysplastic nodules on MRI.

CONCLUSION. Contrast-enhanced MRI can be used as a primary diagnostic method for accurate detection and characterization of HCC 2 cm or larger as required by the criteria of the Model for End-Stage Liver Disease used by the United Network for Organ Sharing. MRI can be considered a standard tool for surveillance before liver transplantation. Reduction in cost and risk may be derived from the diminished need for other diagnostic imaging studies and biopsy and the avoidance of use of iodinated contrast agents in imaging of patients with cirrhosis, many of whom have impaired renal function.

Keywords: gadolinium • hepatocellular carcinoma • liver • MRI • transplantation

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