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Cited by 357Hepatocellular Carcinoma Treatment and PrognosisMRI in cancer diagnosisLiver Disease Diagnosis and Treatment

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MRI With Liver-Specific Contrast for Surveillance of Patients With Cirrhosis at High Risk of Hepatocellular Carcinoma

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Kim, So Yeon, An, Jihyun, Lim, Young-Suk, Han, Seungbong, Lee, Ji-Young, Byun, Jae Ho, Won, Hyung Jin, Lee, So Jung, Lee, Han Chu, Lee, Yung Sang·2017·JAMA Oncology
DOI 10.1001/jamaoncol.2016.3147PMC PMC5470420
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Abstract

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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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)
DOI
10.1001/jamaoncol.2016.3147
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
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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