Evidence map›Paper›PMID 36195953›Full record

ArticleCancer imaging : the official publication of the International Cancer Imaging Society2022

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.

Devang Odedra, Ali Babaei Jandaghi, Rajesh Bhayana, Khaled Y Elbanna, Osvaldo Espin-Garcia, Sandra E Fischer, Anand Ghanekar, Gonzalo Sapisochin, Kartik S Jhaveri

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In one paragraph

Article in Cancer imaging : the official publication of the International Cancer Imaging Society, 2022. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 4 papers, 1 of them a synthesis that pooled it.

0numbers the graph read from it
0cells of the map it votes in
4citing papers in PubMed, 1 pooled it
–field-weighted citation impact
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

4 citing papers in PubMed, 1 synthesis or guideline pooled it.

  1. Pooled it
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  3. Article
  4. Review
4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

9 authors.

Devang OdedraDepartment of Medical Imaging, University Health Network Mount Sinai Hospital and Women's College Hospital, Toronto, ON, Canada.
Ali Babaei JandaghiDepartment of Medical Imaging, University Health Network Mount Sinai Hospital and Women's College Hospital, Toronto, ON, Canada.
Rajesh BhayanaDepartment of Medical Imaging, University Health Network Mount Sinai Hospital and Women's College Hospital University of Toronto, Toronto, ON, Canada.
Khaled Y ElbannaDepartment of Medical Imaging, University Health Network Mount Sinai Hospital and Women's College Hospital University of Toronto, Toronto, ON, Canada.
Osvaldo Espin-GarciaDepartment of Biostatistics, Princess Margaret Cancer Centre, University Health Network, Toronto, ON, Canada.
Sandra E FischerDepartment of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, ON, Canada.
Anand GhanekarDepartment of Surgery, University Health Network and Toronto General Hospital University of Toronto, Toronto, ON, Canada.
Gonzalo SapisochinDepartment of Surgery, University Health Network and Toronto General Hospital University of Toronto, Toronto, ON, Canada.
Kartik S JhaveriDepartment of Medical Imaging, University Health Network Mount Sinai Hospital and Women's College Hospital University of Toronto, Toronto, ON, Canada. kartik.jhaveri@uhn.ca.ORCID http://orcid.org/0000-0003-0938-0321

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

objectivesTo 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.

methodsIn 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.

resultsOne 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.

conclusionHCC 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.

Indexed as

Carcinoma, HepatocellularLiver NeoplasmsLiver TransplantationAgedContrast MediaFemaleGadolinium DTPAHumansLiver CirrhosisMagnetic Resonance ImagingMaleMiddle AgedProspective StudiesRetrospective StudiesSensitivity and SpecificityTomography, X-Ray ComputedContrast MediaGadolinium DTPAgadolinium ethoxybenzyl DTPAGadoxetic acid enhanced magnetic resonance imagingHepatocellular carcinomaLiver imaging and data reporting systemLiver transplantationMilan criteria

Identifiers

PMID36195953
PMCPMC9531508

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Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.