MRI Improves Liver Cancer Screening

Ultrasound not deemed to be sufficiently sensitive to detect early stage liver cancer.

Detecting hepatocellular carcinoma in patients with cirrhosis is currently done with ultrasounds that are administered every 6 months.

But ultrasound is not sufficiently sensitive to detect early stage cancer, a Korean research team writes in JAMA Oncology.

To improve on that situation, So Yeon Kim, MD, PhD and colleagues at the Liver Center, Asan Medical Center in Seoul tried using MRI scans with liver-specific contrast. Liver cancer is a common outcome for untreated hepatitis C virus infection.

Their study involved 407 patients with cirrhosis, who had an estimated annual risk of getting liver cancer of greater than 5%.

The patients had 1 to 3 biannual screening examinations with paired ultrasound and liver-specific contrast enhanced MRI at a tertiary care hospital over a 3-year period ending in August 2014. They were followed with dynamic CT scans at 6 months after the study ended.

Of the patients in the group, 43 had liver cancer at the final screening. One was detected by ultrasound only, 26 by MRI only, 11 by both, and 5 were missed by both methods. That meant the MRI had a detection rate of 86%, compared to 27.9% for the ultrasound approach.

As for false positives, MRI scans had only 3% false positives compared with 5.6% for ultrasound. Of the 43 patients with cancer, 32 had very early stage disease, a single nodule of less than 2 cm, and 67.4% were cured with treatment.

The team concluded that in these high risk patients, MRI with liver-specific contrast resulted in a higher detection rate and lower false-positive findings compared with ultrasound. The MRIs also picked up cancer earlier.

“Whether surveillance with MRI would reduce mortality from liver cancer in high-risk patients requires further investigation,” they concluded, but early stage treatment is “associated with a high chance of curative treatments and favorable survival of patients.”