Impact of Add-On Hepatobiliary Abbreviated Magnetic Resonance Imaging on Ultrasound Hepatoma Surveillance for Liver Cirrhosis- a Randomized Study.

Abstract

Hepatocellular carcinoma (HCC) surveillance with semi-annual ultrasound (US) is recommended for high-risk patients. This study investigates the impact of hepatobiliary abbreviated magnetic resonance imaging (AMRI) performed annually on the recommended US surveillance. Patients with compensated liver cirrhosis at regular HCC surveillance using US and alpha-fetoprotein, with adequate renal function and without HCC diagnosis, were enrolled. Patients were randomized into add-on hepatobiliary AMRI and continuous US surveillance groups. For patients in the AMRI group, gadoxetic acid-enhanced AMRI was performed at enrollment and annually. Liver nodule detection, HCC diagnostic tests, and HCC development were compared between the two groups. One hundred and four patients were initially enrolled, with 15 patients excluded for loss of regular follow-up, giving a total of 89 patients (AMRI: 45 and US: 44) that were analyzed in a median follow-up of 33.6 months. There were no significant differences in baseline characteristics nor statistical differences in hepatic nodule detections (AMRI:10 vs. US:18, p = 0.074) and HCC developments (1 vs. 6, p = 0.058) between the groups. While one HCC with a size of 1.2 cm (BCLC stage:0) was diagnosed in the AMRI group, six HCCs with a mean size of 2.4 cm (BCLC stage 0:2, A:3, B:1) were found in the US group. Compared with the AMRI group, there were more patients in the US group (18 vs. 9, p = 0.032) underwent dynamic imaging and/or biopsy. Curative treatments were performed for all patients with HCC. For compensated cirrhosis patients in the recommended US surveillance, hepatobiliary AMRI annually might reduce the frequency of HCC diagnostic tests.