Kim at
al reported in JAMA Oncology their
experience regarding the accuracy of MRI with liver specific contrast versus
ultrasonography in the surveillance of patients with cirrhosis who are at high
risk in developing hepatocellular carcinoma.
Ultrasonography
(US) is considered the study of choice for screening patients with cirrhosis at
risk of hepatocellular carcinoma. The
current recommendation is for US to be performed every 6 months.
Liver
MRI was performed on a 1.5Tesla scanner and Gadoxetic acid (Primovist) was
administered at a dose of 0.025 mmol/kg.
Axial T1 weighted images of the arterial, portal, delayed and
hepatobilliary phases at 4-mm thickness sections were obtained.
The
authors conducted a prospective study of 407 cirrhotic patients who underwent
semi-annual US and MRI studies. The
patients were followed with dynamic computed tomography 6 months after the
screening imaging studies.
A total
of 407 patients received 1100 screenings with both MRI and US. Hepatocellular carcinomas were diagnosed in
43 patients. Ultrasound diagnosed only one
HCC, MRI detected 26, 11 by both, and 5 were missed by both.
The HCC
detection rate of the MRI was 86%, higher than the 27.9% of US. MRI showed significantly lower false-positive
findings than US, 3% versus 5.6% of US.
Of the 43 patients with HCC 32 had a single less than 2 cm nodule and
received curative treatments. The 3-year
survival of the patients with HCC (86%) was at par to those without HCC.
The 5-year survival rate of HCC is
lower than 20%, and early diagnosis is essential for the possibility of a cure. The current recommendation for patients at
high risk of developing HCC is US needs to be reviewed as the accuracy of US is low.
The
authors conclude that screening of patients with cirrhosis with MRI and liver
specific contrast resulted in higher HCC detection rate and fewer false
positive findings when compared with US.
JAMA
Oncology, Online First, September 22, 2016
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