Hepatocellular Carcinoma Surveillance with Abbreviated MRI Strategies

Take-Away Points

• ■ Major Focus: To review published types of abbreviated MRI protocols for hepatocellular carcinoma (HCC) screening and surveillance.

• ■ Key Result: Studies suggest improved sensitivity for HCC with abbreviated MRI protocols, which can take less than 15 minutes to perform.

• ■ Impact: Future prospective studies that compare US with abbreviated MRI may support increased use of abbreviated MRI for screening and surveillance for HCC.

For persons at high risk for HCC, current guidelines recommend initial screening and follow-up surveillance imaging. The low cost and availability of US typically make this modality the frontline screening method, but US fails to detect one-half of early-stage HCC in patients with cirrhosis; cumulative radiation dose precludes the use of CT for HCC surveillance. While standard MRI protocols are less cost- and time-effective than both US and CT, there is growing interest in abbreviated MRI protocols to improve sensitivity for HCC.

An et al discuss three abbreviated MRI strategies for HCC surveillance. These strategies include (a) images with only dynamic contrast-enhanced MRI; (b) hepatobiliary phase contrast-enhancement protocol supplemented with T2- and diffusion-weighted sequences; and (c) nonenhanced MRI sequences (T1-, T2-, and diffusion-weighted). Sensitivities and specificities of these protocols range from 80% to 90% and 90% to 100%, respectively. All strategies decrease imaging time from 30 minutes for a US study to 15 minutes for an abbreviated MRI protocol (a complete multiphase abdominal MRI typically takes 40 minutes). Depending on the type of abbreviated protocol, a follow-up standard MRI may be required to detect ancillary features of HCC.

Very few studies directly compare US with any of the three abbreviated MRI strategies, but available literature transitively shows increased sensitivity for HCC with abbreviated MRI compared with US. Future prospective studies that directly compare these methodologies may better elucidate which surveillance strategies are optimal for HCC detection.

Highlighted Article

• An J, Peña MA, Cunha GM, et al. Abbreviated MRI for hepatocellular carcinoma screening and surveillance. RadioGraphics 2020;40(7):1916–1931. https://pubs.rsna.org/doi/abs/10.1148/rg.2020200104