Abbreviated MRI and Early-Stage Hepatocellular Carcinoma: What a New Multicenter Study Reveals

Is dynamic abbreviated magnetic resonance imaging (MRI) a viable alternative for diagnosing early-stage hepatocellular carcinoma (HCC)?

In a retrospective multicenter study, recently published in Radiology, researchers assessed the use of dynamic abbreviated MRI for the detection of early-stage HCC among patients with cirrhosis who had liver transplant or resection.¹ The study cohort was comprised of 161 patients with early-stage HCC (median age of 62) and 138 patients (median age of 55) who did not have HCC. For the simulated dynamic abbreviated MRI, researchers selected and reviewed coronal T2-weighted and axial 3D, fat-suppressed T1 dynamic, contrast-enhanced sequences at pre-contrast, late arterial, portal venous and delayed phases from preoperative MRI examinations, according to the study.

Employing liver pathologic findings as a reference standard, the study authors noted a sensitivity rate of 88.2 percent and a specificity rate of 89.1 percent for dynamic abbreviated MRI in the diagnosis of early-stage HCC.¹

Citing a variety of benefits, the researchers suggested the technology could be easily incorporated into workflows at MRI facilities with minimal training.

“The imaging protocol can be easily replicated at most MRI facilities by using 1.5-T or 3.0-T scanners equipped with standard three-dimensional T1-weighted gradient-echo sequences,” wrote lead study author Takeshi Yokoo, M.D., Ph.D., the medical director of MRI at the Harold C. Simmons Comprehensive Cancer Center in Dallas, and an associate professor of radiology at the University of Texas Southwestern Medical Center, and colleagues. “The workflow is non-disruptive, and the need for technologist education is minimal. LI-RADS (Liver Imaging Reporting and Data System) interpretation of dynamic abbreviated MRI is analogous to multiphase CT interpretation and offers all LI-RADS major features needed for category LR-5 classification.”

The researchers also maintained that abbreviated MRI could be an alternative to ultrasound for HCC screening and surveillance in obese patients and those with non-viral etiologies of cirrhosis.

“We did not find the sensitivity of abbreviated MRI to be modulated by obesity or by cause of cirrhosis, an important finding considering that (ultrasound) has worse visualization and performance in patients with obesity and those with non-viral causes of cirrhosis,” noted Yokoo and colleagues.^2,3 “Our findings therefore suggest that abbreviated MRI may serve as a viable surveillance strategy in these patients in whom (ultrasound) may be problematic.”

However, the researchers did acknowledge variation in the sensitivity rates for abbreviated MRI in regard to the Child-Pugh scoring system for cirrhosis. For patients with Child-Pugh class A cirrhosis, Yokoo and colleagues found high sensitivity rates for a variety of lesion sizes (83.3 percent for 1 to 1.9 cm tumors; 96.8 percent for 2 to 2.9 cm tumors; and 98.1 percent for tumors > 3 cm). The authors also found moderate sensitivity for Child-Pugh class B and C cirrhosis (61.1 percent for 1 to 1.9 cm tumors; 64.3 percent for 2 to 2.9 cm tumors; and 71.4 percent for tumors > 3 cm).¹

(Editor's note: For related articles, see "Could Contrast-Enhanced Ultrasound with Perfluorobutane Provide a Viable Option for Diagnosing Hepatocellular Carcinoma?" and "Study Says Machine Learning MRI Model May Help Predict Recurrence Risk of Hepatocellular Carcinoma.")

While noting the potential of dynamic abbreviated MRI for diagnosing HCC in patients with compensated cirrhosis, Yokoo and colleagues said prospective studies are necessary to validate their findings and provide clarity into the lower sensitivity they noted in patients with decompensated cirrhosis.

In an accompanying editorial, Harrison Kim, Ph.D., M.B.A., said it remains to be seen whether abbreviated MRI would be a more cost-effective option for HCC surveillance in comparison to computed tomography (CT) or contrast-enhanced ultrasound.⁴

“Although MRI cost varies across different countries and facilities, it is unlikely that the cost will be less than that of a CT or contrast-enhanced (ultrasound) examination, even after being reduced by 30%,” noted Dr. Kim, a professor in the Division of Advanced Medical Imaging Research in the Department of Radiology at the Heersink School of Medicine at the University of Alabama at Birmingham. “Although MRI generally yields higher contrast than CT, four-phase dynamic CT has demonstrated comparable accuracy with MRI in detecting HCC. CT is faster than abbreviated MRI for active HCC surveillance (10 minutes vs. 20 minutes) with minimal motion artifact and without inducing claustrophobia.”

References

1. Yokoo T, Masaki N, Parikh ND, et al. Multicenter validation of abbreviated MRI for detecting early-stage hepatocellular carcinoma. Radiology. 2023 Jan 24;220917. doi: 10.1148/radiol.220917. Online ahead of print.

2. Chong N, Schoenberger H, Yekkaluri S, et al. Association between ultrasound quality and test performance for HCC surveillance in patients with cirrhosis: a retrospective cohort study. Ailment Pharmacol Ther. 2022;55(6):683-690.

3. Schoenberger H, Chong N, Fetzer DT, et al. Dynamic changes in ultrasound quality for hepatocellular carcinoma screening in patients with cirrhosis. Clin Gastroenterol Hepatol. 2022;20(7):1561-1569.e4.

4. Kim H. The feasibility of abbreviated MRI for active surveillance of hepatocellular carcinoma. Radiology. 2023 Jan 24;223113. doi: 10.1148/radiol.223113. Online ahead of print.