Comparative efficacy of an optimal exam between ultrasound versus abbreviated MRI for HCC screening in NAFLD cirrhosis: A prospective study

Abstract

Background: Retrospective studies report that visualisation of the liver may be severely limited using ultrasound (US), potentially contributing to diminished sensitivity for detection of hepatocellular carcinoma (HCC) among patients with nonalcoholic fatty liver disease (NAFLD) and cirrhosis, but there are limited prospective data. Aims:To compare liver visualisation scores prospectively for US and abbreviated hepatobiliary phase (HBP) magnetic resonance imaging (AMRI) in a cohort of participants with NAFLD cirrhosis and a clinical indication for HCC surveillance. Methods:This prospective multicenter study included 54 consecutive participants (67% women) with NAFLD cirrhosis who underwent contemporaneous US as well as HBP-AMRI with gadoxetic acid. Primary outcome was the proportion of imaging examinations with severe limitations in liver visualisation (visualisation score C) compared head-to-head between US and AMRI. Results:The mean (± standard deviation) age was 63.3 years (±8.4) and body mass index was 32.0 kg/m 2 (±6.0). Nineteen participants (35%) had severe visualisation limitations on US, compared with 10 (19%) with AMRI, p < 0.0001. Nine (17%) participants had <90% of the liver visualised on US, compared with only 1 (2%) participant with AMRI, p < 0.0001. Obesity was a strong and independent predictor for severe visualisation limitation on US (OR 5.1, CI 1.1-23.1, p = 0.03), after adjustment for age, sex and ethnicity. Conclusion:More than one-third of participants with NAFLD cirrhosis had severe visualisation limitations on US for HCC screening, compared with one-sixth on AMRI. US adequacy should be reported in all clinical studies and when suboptimal then AMRI may be considered for HCC screening.

Editorial: screening for hepatocellular carcinoma in NAFLD—towards abbreviated MRI alternative in patients with obesity?

“…7 The study performed by Huang et al provides additional evidence of the limitations of US in patients with NAFLD-related cirrhosis and potential benefit of HCC screening using AMRI. 8 Taking advantage of a prospective study design, both US and AMRI were concomitantly performed by trained operators and analysed by a trained blinded radiologist in well-characterised patients with NAFLD-related cirrhosis. Despite a relatively small number of 54 participants, this study reported a significant higher proportion of visualisation limitations on US compared with AMRI.…”

Editorial: screening for hepatocellular carcinoma in NAFLD cirrhosis—towards abbreviated MRI alternative in patients with obesity? Authors' reply

“…Suboptimal visualisation quality on US performed for HCC surveillance is associated with false negative and false positive findings, potentially leading to harm 9 . Therefore, alternative surveillance strategies are required for patients with suboptimal visualisation quality on US, such as magnetic resonance imaging (MRI) protocols 2,10 . The current study represents the first prospective, head‐to‐head comparative study between US and abbreviated magnetic resonance imaging (AMRI) for HCC surveillance in NASH cirrhosis and suggests that AMRI provides better visualisation quality than US.…”

“…9 Therefore, alternative surveillance strategies are required for patients with suboptimal visualisation quality on US, such as magnetic resonance imaging (MRI) protocols. 2,10 The current study represents the first prospective, head-to-head comparative study between US and abbreviated magnetic resonance imaging (AMRI) for HCC surveillance in NASH cirrhosis and suggests that AMRI provides better visualisation quality than US.We acknowledge that the number of included participants was modest, however, a-priori sample size calculation determined that the study was sufficiently powered to detect a difference in the proportion of severely limited exams between US and AMRI. 2 In addition, we would like to clarify that decompensated patients were not excluded from this study, however, the majority (96%) of included participants had a MELD score of <15.…”

“…

We thank Drs Lebossé and Caussy for their thoughtful comments regarding our study. 1,2 The global prevalence of non-alcoholic fatty liver disease (NAFLD), non-alcoholic steatohepatitis (NASH) cirrhosis and NAFLD-related hepatocellular carcinoma (HCC) is rising rapidly in parallel with the obesity epidemic. [3][4][5][6] Patients with NASH cirrhosis are recommended to undergo 6-monthly HCC surveillance with ultrasound, with the aim of detecting HCC early.

…”

“…We thank Drs Lebossé and Caussy for their thoughtful comments regarding our study 1,2 . The global prevalence of non‐alcoholic fatty liver disease (NAFLD), non‐alcoholic steatohepatitis (NASH) cirrhosis and NAFLD‐related hepatocellular carcinoma (HCC) is rising rapidly in parallel with the obesity epidemic 3–6 .…”