Synergistic Use of Non-Contrast Abbreviated MRI and AFP for HCC Screening

Overview

This study evaluates the diagnostic performance of non-contrast abbreviated MRI (NC-AMRI) combined with alpha-fetoprotein (AFP) and dynamic contrast-enhanced abbreviated MRI (Dyn-AMRI) compared to complete MRI for hepatocellular carcinoma (HCC) detection in at-risk patients. NC-AMRI plus AFP showed promising sensitivity and specificity, suggesting a potential effective screening strategy.

Background

Cirrhosis prevalence is rising globally, increasing the risk of hepatocellular carcinoma (HCC), a leading cause of death. Current guidelines recommend bi-annual ultrasound (US) with or without AFP for HCC surveillance, but US has limited sensitivity for early HCC detection, especially in patients with large body habitus or advanced cirrhosis. MRI is the reference standard for HCC diagnosis but is not routinely used for surveillance due to cost and accessibility issues. Abbreviated MRI (AMRI) protocols, including non-contrast and dynamic contrast-enhanced sequences, are being explored to improve surveillance efficiency and accuracy.

Data Highlights

Key Findings

• Ultrasound has limited sensitivity (~47%) for early HCC detection, especially in patients with large body habitus or advanced cirrhosis.
• Non-contrast abbreviated MRI (NC-AMRI) combined with AFP improves sensitivity for HCC detection compared to US alone.
• Dynamic contrast-enhanced abbreviated MRI (Dyn-AMRI) offers a shorter acquisition time than complete MRI while maintaining diagnostic performance.
• NC-AMRI protocols include fat-suppressed T2-weighted imaging and diffusion-weighted imaging, with an average acquisition time of 7 minutes.
• Study included 351 patients with 631 MRIs, analyzed by experienced radiologists using adapted LI-RADS scoring systems.

Clinical Implications

The combination of NC-AMRI and AFP may provide a more sensitive and efficient screening tool for HCC in at-risk populations compared to ultrasound alone. Abbreviated MRI protocols can reduce scan time and costs, potentially increasing accessibility and adherence to surveillance programs. Incorporating these methods could improve early HCC detection and patient outcomes.

Conclusion

NC-AMRI combined with AFP shows promise as an effective HCC surveillance strategy, offering improved sensitivity over ultrasound with shorter acquisition times than complete MRI. Further prospective studies are warranted to validate these findings and optimize screening protocols.

References

1. EASL Clinical Practice Guidelines 2018 -- Management of Hepatocellular Carcinoma
2. AASLD Guidelines 2018 -- Hepatocellular Carcinoma Surveillance
3. Korean Prospective Study 2019 -- Comparison of US and NC-AMRI Sensitivity
4. Meta-Analysis 2017 -- Role of AFP in HCC Surveillance