BackgroundHepatocellular carcinoma (HCC) guidelines recommend ultrasound screening in high-risk patients. However, in some patients, ultrasound image quality is suboptimal due to factors such as hepatic steatosis, cirrhosis, and confounding lesions. Our aim was to investigate an abbreviated non-contrast magnetic resonance imaging (aNC-MRI) protocol as a potential alternative screening method.MethodsA retrospective study was performed using consecutive liver MRI studies performed over 3 years, with set exclusion criteria. The unenhanced T2-weighted, T1-weighted Dixon, and diffusion-weighted sequences were extracted from MRI studies with a known diagnosis. Each anonymised aNC-MRI study was read by three radiologists who stratified each study into either return to 6 monthly screening or investigate with a full contrast-enhanced MRI study.ResultsA total of 188 patients were assessed; 28 of them had 42 malignant lesions, classified as Liver Imaging Reporting and Data System 4, 5, or M. On a per-patient basis, aNC-MRI had a negative predictive value (NPV) of 97% (95% confidence interval [CI] 95–98%), not significantly different in patients with steatosis (99%, 95% CI 93–100%) and no steatosis (97%, 95% CI 94–98%). Per-patient sensitivity and specificity were 85% (95% CI 75–91%) and 93% (95% CI 90–95%).ConclusionOur aNC-MRI HCC screening protocol demonstrated high specificity (93%) and NPV (97%), with a sensitivity (85%) comparable to that of ultrasound and gadoxetic acid contrast-enhanced MRI. This screening method was robust to hepatic steatosis and may be considered an alternative in the case of suboptimal ultrasound image quality.

No abstract

Core tip: This article examines the role of current diagnostic modalities for the investigation of obscure gastrointestinal bleeding (OGIB) and outcomes in patients undergoing these investigations. Capsule endoscopy and double balloon enteroscopy remain the cornerstone of diagnostic and therapeutic management. The diagnostic and therapeutic capabilities of certain modalities are influenced by the nature of bleeding in OGIB. Longterm outcome data in patients with OGIB is limited but is most promising for capsule endoscopy.Santhakumar C, Liu K. Evaluation and outcomes of patients with obscure gastrointestinal bleeding. World J Gastrointest Pathophysiol 2014; 5(4