Hepatology (Baltimore, Md.) · 2026
Noncontrast abbreviated MRI demonstrates superior diagnostic accuracy compared to ultrasound for hepatocellular carcinoma detection: Interim results from a prospective surveillance trial.
СтатьяНазвание и аннотация: Перевод в очереди
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Gupta Pankaj, Singh Shravya, Gulati Ajay, Mudgil Priya, Kalra Naveen, Dutta Niharika, Aggarwal Yashika, Bhujade Harish, Chaluvashetty Sreedhara, Premkumar Madhumita, Taneja Sunil, Verma Nipun, De Arka, Sharma Vishal, Sandhu Manavjit S, Singh Virendra, Duseja Ajay
Аннотация
BACKGROUND AND AIMS: To prospectively evaluate the diagnostic performance of a rapid abbreviated noncontrast MRI (AMRI) protocol compared to ultrasound (US) for HCC surveillance in a high-risk population with cirrhosis.
APPROACH AND RESULTS: This prospective, single-center, diagnostic accuracy study (ClinicalTrials.gov: NCT05716620) enrolled patients with cirrhosis and annual HCC risk >5%. Participants underwent paired screening with US and noncontrast AMRI across 2 rounds, 6 months apart. Patients with positive findings on either imaging modality or clinical suspicion of HCC underwent multiphasic contrast-enhanced MRI (CE-MRI) as the reference standard. The primary outcome was the HCC detection rate (per-patient sensitivity) comparing AMRI and US. In 614 paired screening examinations across 404 patients, 97 underwent CE-MRI (based on positive screening), identifying 39 HCCs in 37 patients. AMRI demonstrated significantly superior sensitivity (94.6% [95% CI: 83.3-98.9] vs. 51.4% [95% CI: 34.7-67.8]; p <0.001) and specificity (96.6% [95% CI: 88.9-99.5] vs. 69.5% [95% CI: 55.8-80.8]; p <0.001). AUROC was 0.956 [95% CI: 0.913-0.997] vs. 0.604 [95% CI: 0.469-0.738] ( p <0.001). In the per-lesion analysis, AMRI detected 37 of 39 lesions (94.9%) versus US 20 of 39 (51.3%). Of HCCs detected by AMRI, 97.3% were early-stage Barcelona Clinic Liver Cancer Staging System 0 or A]. Interobserver agreement was "almost perfect" for AMRI (κ=0.929) versus "moderate" for US (κ=0.631).
CONCLUSIONS: A rapid, noncontrast AMRI protocol shows superior per-patient sensitivity compared to US for HCC detection in patients with cirrhosis under surveillance. While these diagnostic findings are encouraging, prospective trials evaluating patient-level outcomes are essential before definitive guideline recommendations can be made.
APPROACH AND RESULTS: This prospective, single-center, diagnostic accuracy study (ClinicalTrials.gov: NCT05716620) enrolled patients with cirrhosis and annual HCC risk >5%. Participants underwent paired screening with US and noncontrast AMRI across 2 rounds, 6 months apart. Patients with positive findings on either imaging modality or clinical suspicion of HCC underwent multiphasic contrast-enhanced MRI (CE-MRI) as the reference standard. The primary outcome was the HCC detection rate (per-patient sensitivity) comparing AMRI and US. In 614 paired screening examinations across 404 patients, 97 underwent CE-MRI (based on positive screening), identifying 39 HCCs in 37 patients. AMRI demonstrated significantly superior sensitivity (94.6% [95% CI: 83.3-98.9] vs. 51.4% [95% CI: 34.7-67.8]; p <0.001) and specificity (96.6% [95% CI: 88.9-99.5] vs. 69.5% [95% CI: 55.8-80.8]; p <0.001). AUROC was 0.956 [95% CI: 0.913-0.997] vs. 0.604 [95% CI: 0.469-0.738] ( p <0.001). In the per-lesion analysis, AMRI detected 37 of 39 lesions (94.9%) versus US 20 of 39 (51.3%). Of HCCs detected by AMRI, 97.3% were early-stage Barcelona Clinic Liver Cancer Staging System 0 or A]. Interobserver agreement was "almost perfect" for AMRI (κ=0.929) versus "moderate" for US (κ=0.631).
CONCLUSIONS: A rapid, noncontrast AMRI protocol shows superior per-patient sensitivity compared to US for HCC detection in patients with cirrhosis under surveillance. While these diagnostic findings are encouraging, prospective trials evaluating patient-level outcomes are essential before definitive guideline recommendations can be made.