Inpatient versus Outpatient MRI? Outcomes for Discharged patients with Newly Diagnosed Hepatocellular Carcinoma

From the 2023 HVPA National Conference

Ho-Man Yeung MD (Temple University Hospital)

Background:
Patients with primary liver mass(es) often require advanced imaging for further characterization and diagnosis. Outpatient MRI study is difficult to coordinate and patients with hepatocellular carcinoma (HCC) may have accompanying liver failure. Here, we compare outcomes between patients who receive an inpatient MRI and those who did not receive an inpatient MRI, following detection of suspicious liver mass during hospitalization.

Objective:
To determine the utilization and outcomes between patients who received inpatient MRI versus those who did not.

Methods:
This is a retrospective review of hospitalized patients at Temple University Hospital of two years, from Jan 1, 2020 through Dec 31, 2021. Patients are included if they have newly diagnosed HCC, and excluded if HCC is known from prior encounters or if the diagnosis is not HCC. Patients designated for hospice during hospitalization were excluded, as work up would be forgone. Outcome of interests included metastatic rate on initial presentation, LOS, mortality rates, time from discharged to treatment, time from admission to inpatient MRI, and overall follow up rate.

Results: 
34 unique subjects remained after review, with 22 receiving MRI as inpatient (IP) and 12 who did not receive an inpatient MRI (non-IP). Subjects were 80% male, 86% Black or Hispanic, 37% with chronic hepatitis C, 41% current or past alcohol use disorder, 39% type 2 diabetes mellitus. No patients met Milan criteria and only 1 patient was treated with curative intent. Two patients were transitioned to hospice by their oncologists after treatment failure. The IP group were ordered hepatology appointment request upon discharge more often compared to non-IP group (82% v 44%). Time from admission to inpatient MRI averaged 2.2days. 7 of 12 patients in the non-IP group obtained follow up MRI after discharge. IP group had lower rates of patients lost to follow up (4% v 42%). Inpatient LOS between the two groups were similar (6days v 7days). Overall, rate of survival beyond 1 year was poor, 11(50%) in IP group vs 5(42%) in non-IP group (however, same 5 patients were also lost to follow up). 72% of death occurred within 90 days after discharge. Median time from discharge to cancer treatment is similar between the two groups (31days v 34 days), however more patients received cancer treatment after discharge (68% v 42%).

Conclusions:
HCC has high mortality rates and overall poor clinical outcome. Patients in the IP group exhibited higher rates of cancer treatment, fewer lost to follow up, and higher discharge appointment request. IP MRI did not overall increase inpatient LOS.

Clinical Implications:
Obtaining an inpatient MRI prior to discharge may benefit select patients, associated with increased follow up rate and cancer treatment rate for HCC.

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