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MRI With Liver-Specific Contrast for Surveillance of Patients With Cirrhosis at High Risk of Hepatocellular Carcinoma
Open accessAbstract
IMPORTANCE: Current recommendations for patients with cirrhosis are to undergo surveillance for hepatocellular carcinoma (HCC) with ultrasonography (US) every 6 months. However, the sensitivity of US screening to detect early-stage HCC is suboptimal. Magnetic resonance imaging (MRI) with liver-specific contrast may detect additional HCCs missed by US in high-risk patients with cirrhosis. OBJECTIVE: To compare the HCC detection rate of US and MRI in patients with cirrhosis who are at high risk for HCC. DESIGN, SETTING, AND PARTICIPANTS: A prospective surveillance study of 407 patients with cirrhosis and an estimated annual risk of HCC greater than 5% who underwent 1 to 3 biannual screening examinations with paired US and liver-specific contrast-enhanced MRI at a tertiary care hospital between November 2011 and August 2014. All patients were followed-up with dynamic computed tomography (CT) at 6 months after the study. The confirmation of HCC was based on the results of histologic examination and/or typical CT images of HCC. MAIN OUTCOMES AND MEASURES: HCC detection rates and false-positive findings of US vs MRI. RESULTS: A total of 407 eligible patients received 1100 screenings with paired US and MRI. Hepatocellular carcinomas were diagnosed in 43 patients: 1 detected by US only, 26 by MRI only, 11 by both, and 5 were missed by both. The HCC detection rate of MRI was 86.0% (37/43), significantly higher than the 27.9% (12/43) of US (P < .001). Magnetic resonance imaging showed a significantly lower rate of false-positive findings than US (3.0% vs 5.6%; P = .004). Of the 43 patients with HCC, 32 (74.4%) had very early-stage HCC (a single nodule <2 cm), and 29 (67.4%) received curative treatments. The 3-year survival rate of the patients with HCC (86.0%) was not inferior to those without HCC (94.2%; hazard ratio, 2.26; 95% CI, 0.92-5.56; P = .08). CONCLUSIONS AND RELEVANCE: In patients with cirrhosis at high-risk of HCC, screening that used MRI with liver-specific contrast resulted in a higher HCC detection rate and lower false-positive findings compared with US. With MRI screening, most of the cancers detected were at very early stage, which was associated with a high chance of curative treatments and favorable survival of patients. Whether surveillance with MRI would reduce mortality from HCC in high-risk patients requires further investigation. TRIAL REGISTRATION: clinicaltrials.gov Identifier: NCT01446666.
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“According to the prospective PRIUS study, MRI had signi fi cantly higher sensitivity (85.7% vs. 26.2%) and speci fi city (97.0% vs. 94.4%) than ultrasound for early HCC detection. 252”
From EASL-EASD-EASO Clinical Practice Guidelines on the management of metabolic dysfunction-associated steatotic liver disease (MASLD). (2024) · cites this paper as [252]
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Self-citationKim, N. J., Rozenberg‐Ben‐Dror, K., Jacob, D. A., Rich, N. E., Singal, A. G., Aby, E. S., Yang, J. D., Nguyen, V., Pillai, A. A., Fuchs, M. A., et al. (2020) · Clinical Gastroenterology and Hepatology · doi:10.1016/j.cgh.2020.09.015 · Cited by 37
Management of patients with pre-therapeutic advanced liver fibrosis following HCV eradication
Nahon, P., & Ganne‐Carrié, N. (2019) · JHEP Reports · doi:10.1016/j.jhepr.2019.11.001 · Cited by 36
Kim, S. U., Seo, Y. S., Lee, H. A., Kim, M. N., Kim, E. H., Kim, H. Y., Lee, Y. R., Lee, H. W., Park, J. Y., Kim, D. Y., et al. (2019) · Clinical Gastroenterology and Hepatology · doi:10.1016/j.cgh.2019.06.028 · Cited by 36
Self-citationClinical practice guideline and real-life practice in hepatocellular carcinoma: A Korean perspective
Goh, M. J., Sinn, D. H., Kim, J. M., Lee, M. W., Hyun, D. H., Yu, J. I., Hong, J. Y., & Choi, M. S. (2023) · Clinical and Molecular Hepatology · doi:10.3350/cmh.2022.0404 · Cited by 35
Park, H. J., Seo, N., & Kim, S. Y. (2022) · Korean Journal of Radiology · doi:10.3348/kjr.2021.0896 · Cited by 35
Self-citationCell-free DNA testing for early hepatocellular carcinoma surveillance
Chen, L., Wu, T., Fan, R., Qian, Y.-S., Liu, J., Bai, J., Zheng, B. J., Liu, X., Zheng, D., Du, L., et al. (2024) · EBioMedicine · doi:10.1016/j.ebiom.2023.104962 · Cited by 37
Kim, S. U., Seo, Y. S., Lee, H. A., Kim, M. N., Lee, E. J., Shin, H. J., Lee, Y. R., Lee, H. W., Park, J. Y., Kim, D. Y., et al. (2020) · Cancer Epidemiology Biomarkers & Prevention · doi:10.1158/1055-9965.epi-19-0614 · Cited by 34
Self-citationEmerging and Clinically Accepted Biomarkers for Hepatocellular Carcinoma
Fares, S., Wehrle, C. J., Hong, H., Sun, K., Jiao, C., Zhang, M., Gross, A. R., Allkushi, E., Uysal, M., Kamath, S. D., et al. (2024) · Cancers · doi:10.3390/cancers16081453 · Cited by 33
Human microbiome is a diagnostic biomarker in hepatocellular carcinoma
Rao, B., Lou, J., Wang, W., Li, A., Cui, G., Yu, Z., & Ren, Z. (2020) · Hepatobiliary & pancreatic diseases international · doi:10.1016/j.hbpd.2020.01.003 · Cited by 33
Authors, & Collaborators: (2022) · Zeitschrift für Gastroenterologie · doi:10.1055/a-1880-2388 · Cited by 30
Teng, W., Wang, H., Lin, S., & On behalf of Diagnosis Group and Systemic Therapy Group of TLCA (2024) · Liver Cancer · doi:10.1159/000537686 · Cited by 36
Jaber, F. S., Cholankeril, G. T., & El‐Serag, H. B. (2024) · Journal of the Canadian Association of Gastroenterology · doi:10.1093/jcag/gwae025 · Cited by 33
He, L., Zhang, Y., Chen, J., Liu, G., Zhu, J., Li, X., Li, D., Yang, Y., Lee, C., Shi, J., et al. (2021) · Journal of Materials Chemistry B · doi:10.1039/d1tb01729b · Cited by 30
Esposito, A., Buscarino, V., Raciti, D., Casiraghi, E., Manini, M. A., Biondetti, P. R., & Forzenigo, L. V. (2019) · La radiologia medica · doi:10.1007/s11547-019-01092-y · Cited by 29
Stratification of Hepatocellular Carcinoma Risk Following HCV Eradication or HBV Control
Nahon, P., Quang, E. V., & Ganne‐Carrié, N. (2021) · Journal of Clinical Medicine · doi:10.3390/jcm10020353 · Cited by 29
Status of, and strategies for improving, adherence to HCC screening and surveillance
Francica, G., & Borzio, M. (2019) · Journal of Hepatocellular Carcinoma · doi:10.2147/jhc.s159269 · Cited by 30
Kim, Y., An, C., Kim, D. Y., Aljoqiman, K. S., Choi, J., & Kim, M. (2019) · ULTRASONOGRAPHY · doi:10.14366/usg.18051 · Cited by 28
Nadarević, T., Colli, A., Giljača, V., Fraquelli, M., Casazza, G., Manzotti, C., Štimac, D., & Miletić, D. (2022) · Cochrane Database of Systematic Reviews · doi:10.1002/14651858.cd014798.pub2 · Cited by 28
Wary, P., Hossu, G., Ambarki, K., Nickel, D. M., Arberet, S., Oster, J., Orry, X., & Laurent, V. (2023) · European Radiology · doi:10.1007/s00330-023-09693-y · Cited by 27
Rhee, H., Kim, M., Kim, D. Y., An, C., Kang, W., Han, K., Roh, Y. H., Han, K., Ahn, S. H., Choi, J., et al. (2025) · Gastroenterology · doi:10.1053/j.gastro.2024.12.035 · Cited by 27
Self-citation
Metadata
- Authors
- Kim, S. Y., An, J., Lim, Y.-S., Han, S., Lee, J.-Y., Byun, J. H., Won, H. J., Lee, S. J., Lee, H. C., & Lee, Y. S.
- Affiliations
- Asan Medical Center (KR)
- Gachon University (KR)
- Department of Gastroenterology, Liver Center, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
- Corresponding author
- Lim, Young-Suk
- ORCID
- Venue
- JAMA Oncology
- Publisher
- American Medical Association (AMA)
- Published
- 2017-04-01
- Volume
- 3
- Issue
- 4
- Pages
- 456
- ISSN
- 2374-2437 (ISSN-L)
- PMC
- PMC5470420
- OpenAlex
- W2496240332
- Cited by
- 356
- References
- 26
- Citations by year
- 2026: 31 · 2025: 46 · 2024: 40 · 2023: 42 · 2022: 44 · 2021: 45 · 2020: 55 · 2019: 29 · 2018: 15 · 2017: 8
- FWCI
- 12.78
- Type
- journal article
- Language
- en
- Open access
- green
- europepmc.org
- Locations
- JAMA Oncology (publishedVersion)
- Europe PMC (PubMed Central) (publishedVersion)
- PubMed Central (publishedVersion)
- PubMed (publishedVersion)
- Topics
- Health Sciences › Medicine › Hepatology › Hepatocellular Carcinoma Treatment and Prognosis
- Health Sciences › Medicine › Radiology, Nuclear Medicine and Imaging › MRI in cancer diagnosis
- Health Sciences › Medicine › Hepatology › Liver Disease Diagnosis and Treatment
- Keywords
- hepatocellular carcinoma, liver cirrhosis, HCC surveillance, ultrasonography, false positives, liver cancer screening
- MeSH terms
- Contrast Media, False Positive Reactions, Female, Carcinoma, Hepatocellular, Humans, Liver Cirrhosis, Liver Neoplasms, Magnetic Resonance Imaging, Male, Middle Aged, Prospective Studies, Early Detection of Cancer
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