Visualization quality and effectiveness of noncontrast-abbreviated magnetic resonance imaging for hepatocellular carcinoma surveillance in cirrhotic patients with ultrasound visualization score C.
retrospective_cohort · Level III
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- Also identified by DOI 10.1007/s00330-026-12822-y.
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Abstract
The recently updated Liver Imaging Reporting and Data System version 2024 Surveillance US algorithm introduced alternative strategies, including abbreviated MRI, for patients with repeat or at high risk for repeat US visualization score C (VIS-C) examinations. This study aimed to evaluate the liver visualization quality and the effectiveness of noncontrast-abbreviated MRI (NC-AMRI) for hepatocellular carcinoma (HCC) surveillance in cirrhotic patients with US VIS-C. This retrospective study included Child-Pugh class A or B cirrhotic patients with prior US VIS-C and who underwent NC-AMRI for HCC surveillance between December 2018 and July 2022. Two radiologists independently assessed the visualization quality based on liver parenchymal heterogeneity, artifacts, and liver visualization range, and assigned visualization scores (VIS-A, no or minimal limitations; VIS-B, moderate limitations; and VIS-C, severe limitations) on diffusion-weighted image (DWI) and T2-weighted image (T2WI) of NC-AMRI. Early-stage HCC detection was determined. A total of 264 patients (mean age, 60.2 years; 169 men) were included. In NC-AMRI after US VIS-C, the visualization score on DWI was A in 60.6% (160/264), B in 31.1% (82/264), and C in 8.3% (22/264), and the visualization score on T2WI was A in 78.4% (207/264), B in 16.7% (44/264), and C in 4.9% (13/264). Of the 18 patients detected with HCCs in NC-AMRI, 17 patients (94.4%) had early-stage HCC. NC-AMRI provided adequate visualization quality in more than 91% of cirrhotic patients with US VIS-C and demonstrated effectiveness for early-stage HCC detection. Question What are the liver visualization quality and the effectiveness of noncontrast-abbreviated MRI (NC-AMRI) for hepatocellular carcinoma (HCC) surveillance in cirrhotic patients with US visualization score C (VIS-C)? Findings After US VIS-C, NC-AMRI achieved VIS-A or B in 91.7% on DWI and 95.1% on T2WI; among 18 HCCs detected, 94.4% were early stage. Clinical relevance NC-AMRI may provide acceptable liver visualization (DWI 91.7%, T2WI 95.1%) in US VIS-C cirrhosis and may facilitate early-stage HCC detection (94.4% early); findings warrant confirmation in larger, prospective, multi-center cohorts.