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MRI bests ultrasound for early detection of HCC

Magnetic resonance imaging — as opposed to ultrasound — offers a significantly greater chance of detecting hepatocellular carcinoma early, according to a prospective surveillance study published in JAMA Oncology.

“MRI with liver-specific contrast agent markedly outperformed ultrasonography, which is considered a current standard tool according to practice guidelines,” Young-Suk Lim, MD, PhD, of the Liver Center at the Asan Medical Center in Korea, told Healio.com/Hepatology. “MRI screening for a high-risk population of hepatocellular carcinomas can help doctors to detect HCCs at very early stage and consequently can open a wide chance of cure and favorable survival for patients.”

Lim and colleagues analyzed 1,100 ultrasound and MRI screenings from 407 participants at high risk for HCC. The tests took place, at most, within 2 weeks of the other, three times over 18 months. Of these, 43 were diagnosed with HCC. MRIs detected HCC 86% of the time vs. 27.9% of the time via ultrasound (P < .001).

When a lesion was discovered using either method, the patient underwent a CT scan within 3 months. Cases that were suspicious on CT imaging had biopsies performed with an ultrasound as much as possible; those lesions only detected by MRI underwent a targeted second-look ultrasound to steer the biopsy results, researchers wrote.

The researchers also found false-positive cases in ultrasound outnumbered MRI (5.6% vs. 3%). The MRI false-positives were attributed to hemangiomas, inflammatory lesions, pseudolesions, cirrhosis-related nodules and abnormal vasculature. The false-positives discovered with ultrasound showed some parallels, with abnormal vasculature, complicated cysts, exophytic hepatic parenchyma, cirrhosis-related nodules and pseudolesions cited as the cause.

According to Lim and colleagues, the estimated 3-year overall survival rate of patients with HCC was 86%. This however was not inferior when compared with 364 patients without HCC (94.2%; HR = 2.26; 95% CI, 0.92-5.56).

“The only curative treatment option is local ablation in many cases, which highlights the importance of surveillance to detect HCCs at a very early stage,” Lim and colleagues wrote.

“The results of our prospective study support our hypothesis that MRI with liver-specific contrast is more sensitive than [ultrasound] to detect early stage HCC in high-risk patients with cirrhosis.” – by Janel Miller

Disclosures: Lim reports serving as an advisory board member for Bayer Healthcare, Bristol-Myers Squibb and Gilead Sciences; and receives research funding from Bayer Healthcare, Bristol-Myers Squibb, Gilead Sciences and Novartis. No other financial disclosures were reported.