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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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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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