HCC screening: assessment of an abbreviated non-contrast MRI protocol

Abstract

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.

Current status of image-based surveillance in hepatocellular carcinoma

“…A prospective surveillance study published in 2020 [ 76 ] found that the sensitivity of non-contrast MRI for diagnosing HCC was 77.1%-79.1%, with a specificity of 97.9%. This result is somewhat different from those of previous studies that analyzed the accuracy of non-contrast MRI (sensitivity, 82.9%-91.7%; specificity, 76.4%-90.7%), but those studies were retrospective in nature or were performed in a diagnostic setting [ 77 - 79 ]. Moreover, a recent comparative study simulating HCC surveillance reported similar sensitivity and specificity between non-contrast MRI and abbreviated MRI using gadoxetic acid [ 80 ].…”

Abbreviated MRI protocol for colorectal liver metastases: How the radiologist could work in pre surgical setting

“…Several papers have investigated abbreviated MRI protocol in cancer detection, including many looking at HCC detection [34][35][36][37][38][39][40][41]. Lee et al [37] compared an abbreviated screening…”

Alternative approach of hepatocellular carcinoma surveillance: abbreviated MRI

“…Motivated to provide higher sensitivity than US while avoiding the limitations of CT and conventional MRI, investigators have developed abbreviated MRI (AMRI) protocols that rely on a small number of select sequences specifically tailored for HCC detection [12,[23][24][25][26][27][28][29][30][31][32][33][34][35][36] . The rationale is that reduced scanner time decreases costs and complexity, while improving patient comfort, without significantly compromising HCC detection.…”