MRI finds more cases of liver cancer than ultrasonography in less time

Nonenhanced MRI showed promise as an option for hepatocellular carcinoma surveillance in high-risk patients based on high-performance results with a short scan time and lack of contrast agent-associated risks, according to a study published in Journal of Hepatology.

According to Hyo Jung Park, MD, from University of Ulsan College of Medicine in the Republic of Korea, and colleagues, recent studies have shown that ultrasonography had a low sensitivity of approximately 63% for detecting early HCC and 20% for very early-stage HCC. Instead, recently revised guidelines suggest that patients with inadequate ultrasonography results be assessed by alternative methods.

“Nonenhanced MRI, consisting of diffusion-weighted imaging (DWI) and T2-weighted imaging (T2WI), may be a candidate alternative surveillance tool for HCC, because diffusion restriction and mild to moderate T2 hyperintensity are ancillary imaging features for malignancy,” the researchers wrote.

Park and colleagues enrolled 382 patients with a high risk for HCC who finished at least one surveillance round with reference examination, either histologic examination or CT. They initially diagnosed 48 cases of HCC in 43 patients and cases of HCC in an additional 29 patients during an average follow-up of 32.9 months.

Nonenhanced MRI had superior per-lesion sensitivity (77.1% vs. 25%; P < .001), per-exam sensitivity (79.1% vs. 27.9%; P < .001), per-exam specificity (97.9% vs. 94.5%; P < .001), per-exam negative predictive value (99.1% vs. 96.9%), per-lesion positive predictive value (56.9% vs. 16.7%) and per-exam positive predictive value (61.8% vs. 17.7%) compared with ultrasonography.

The estimated scan time for DWI and T2WI was less than 6 minutes for nonenhanced MRI. However, patient stay duration of MRI was approximately 25 minutes to 35 minutes compared with 12 minutes to 15 minutes for ultrasonography.

“From a viewpoint of utilizing medical resources, not only scan time but also total room occupancy time need to be considered,” Park and colleagues wrote. “Successful use of MRI for surveillance requires simplification of the scanning method and the evaluation of only essential image sequences, thereby maximizing its efficacy while minimizing surveillance time and cost.” – by Talitha Bennett

Disclosures: The authors report no relevant financial disclosures.