Sheela Agarwal MD, MS, Presenter: Nothing to Disclose

Sandeep Subhash Hedgire MD, Abstract Co-Author: Nothing to Disclose

Elkan F. Halpern PhD, Abstract Co-Author: Research Consultant, Hologic, Inc

Mukesh Gobind Harisinghani MD, Abstract Co-Author: Nothing to Disclose

Pari Pandharipande MD, MPH, Abstract Co-Author: Nothing to Disclose

Debra Ann Gervais MD, Abstract Co-Author: Research Grant, Covidien AG

Peter F. Hahn MD, PhD, Abstract Co-Author: Stockholder, Abbott Laboratories Stockholder, Covidien AG Stockholder, CVS Caremark Corporation Stockholder, Kimberly-Clark Corporation Stockholder, Landauer, Inc

Sanjay Saini MD, Abstract Co-Author: Nothing to Disclose

To evaluate the incremental clinical value of double reading gadoxetate liver MRIs for detection and characterization of liver lesions and incidental findings.

During the 6 month period from 8/1/2012-1/31/2012, 489 patients underwent 544 liver MRIs with the relatively new contrast agent gadoxetate disodium. Each study was read primarily by a fellowship trained staff abdominal radiologist and over-read by a second abdominal radiologist. Change in diagnosis was confirmed by characteristic radiologic findings with consensus review (74%), imaging follow-up (12%), or histopathology (14%). Any interpretive changes were classified by clinical significance and potential change in patient management. Rates of change in diagnosis were analyzed with logistic regression analysis, including reader factors (experience level, percent of workload dedicated to MRI), exam factors (indication, scanner brand, magnet strength) and work related factors (weekend vs weekday read, presence of preliminary read by trainee).

Changes in interpretation occurred on 50 examinations (9.2%) with 23 (4.2%) leading to a potential change in clinical management. On multivariate logistic regression analysis, weekend interpretation was an independent predictor increasing likelihood of a change in interpretation (p < 0.01). In step-wise logistic analysis, reading the study alone (without the preliminary read of a trainee) was also found to be a predictor of an interpretive change (p < 0.02). On univariate logistic analysis, less experience with liver MRI as measured by a smaller percentage of one’s workload dedicated to MRI was a significant factor predicting a miss (p < 0.05). Common interpretative discrepancies included omission of one metastasis in the setting of multiple metastases (13), misinterpretation of HCC (9), misinterpretation of hemangiomas (6) and misinterpretation of FNH and adenomas (8).

Double reading of gadoxetate-enhanced liver MRI results in improved detection and characterization of liver lesions, with a significant effect on clinical management of patients. This may be considered for better clinical practice in divisions with varying levels of reader experience with hepatobiliary contrast agents.

Radiologists initiating use of gadoxetate for liver MRI should consider a period of double reading until all staff have acquired full familiarity with this new contrast agent.

Agarwal, S, Hedgire, S, Halpern, E, Harisinghani, M, Pandharipande, P, Gervais, D, Hahn, P, Saini, S, Improved Accuracy of Gadoxetate Disodium-Enhanced MRI Using a Double Reading Paradigm for Detection and Characterization of Liver Lesions.  Radiological Society of North America 2013 Scientific Assembly and Annual Meeting, December 1 - December 6, 2013 ,Chicago IL. http://archive.rsna.org/2013/13021107.html