MRI with liver contrast edges ultrasound in spotting cancer

Last Updated: 2016-09-28

By David Douglas

NEW YORK (Reuters Health) - Magnetic resonance imaging (MRI) with liver-specific contrast can lead to a higher detection rate for hepatocellular carcinoma (HCC) than standard ultrasound screening, according to Korean researchers.

"Our study demonstrated that, in patients with cirrhosis at high-risk of developing liver cancer (hepatocellular carcinoma), screening with liver-specific contrast-enhanced magnetic resonance imaging markedly outperformed ultrasonography that is the current recommendation by practice guidelines," Dr. Young-Suk Lim of the University of Ulsan College of Medicine, Seoul, told Reuters Health by email.

The research, a prospective surveillance study of 407 patients, was published online September 22 JAMA Oncology.

All patients had cirrhosis and an estimated annual risk of HCC greater than 5.0%. They underwent up to three biannual ultrasound and gadoxetic acid contrast-enhanced MRI screenings between 2011 and 2014. All were followed-up with dynamic computed tomography (CT) at six months after the study.

Overall, the patients received 1,100 paired screenings. HCC was diagnosed and confirmed based on the results of histologic examination and/or typical CT images in a total of 43 patients.

Five cases were missed by both methods, 11 were detected by both methods, 26 were detected by MRI alone and one was detected by ultrasound alone. This amounted to an 86.0% detection rate for MRI, significantly greater than the 27.9% seen with ultrasound.

MRI also had a significantly lower false-positive rate than ultrasound (3.0% vs. 5.6%).

Thirty-two patients (74.4%) had very early stage HCC with a single nodule of less than 2 cm. Of these, 29 received curative treatments.

The three-year overall survival rate was 86.0% in patients with HCC, "despite the severely limited access to liver transplantation," the researchers note. In fact, they point out, this was not significantly lower than the 94.2% overall survival seen in the 364 patients without HCC.

Dr. Lim concluded, "MRI screening for a high-risk population may help detecting liver cancers at a very early stage, and consequently can allow a high chance of cure and favorable survival of patients."

Dr. Jia-Horng Kao of the National Taiwan University College of Medicine in Taipei, who wrote an accompanying editorial, told Reuters Health by email, "Although the authors raised the novel idea of MRI surveillance for HCC, whether we can recommend gadoxetic acid-enhanced MRI for HCC surveillance is still an open question, and it may only be considered in high-risk patients."

SOURCE: http://bit.ly/2dqREle and http://bit.ly/2cBX23Z

JAMA Oncol 2016.