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.
Highlights
Hepatocellular carcinoma (HCC) guidelines recommend ultrasound screening in high-risk patients
* Correspondence: stephen.john.mcdonald@gmail.com 1Department of Radiology, Concord Repatriation General Hospital, Sydney, NSW, Australia Full list of author information is available at the end of the article. This screening method was robust to hepatic steatosis and may be considered an alternative to screen high-risk patients in the case of suboptimal ultrasound image quality
Early detection of HCC is crucial in increasing survival, but currently, only four in ten hepatocellular carcinomas are detected at an early stage [4]
Summary
Hepatocellular carcinoma (HCC) guidelines recommend ultrasound screening in high-risk patients. In some patients, ultrasound image quality is suboptimal due to factors such as hepatic steatosis, cirrhosis, and confounding lesions. Curative treatments are only available when detected at an early stage, where the 5-year survival is 50–70%. All recommend screening with ultrasound (generally 6 monthly) for high-risk groups, including all patients with cirrhosis and some non-cirrhotic patients positive for hepatitis B virus (HBV) infection (Table 1). All guidelines recommend further evaluation with multiphase computed tomography (CT) or magnetic resonance imaging (MRI) for patients with a positive screening test [5, 6, 8,9,10,11,12,13] (Table 1). The impact of ultrasound with AFP for HCC screening was demonstrated in 2004 by Zhang et al [15] with a large randomised controlled trial that yielded a significant decrease in mortality in a Chinese population with a high prevalence of HBV
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