Noncontrast MRI Outperforms Ultrasound in Liver Cancer Surveillance
A randomized trial published in Gastroenterology comparing ultrasonography (US) and noncontrast magnetic resonance imaging (MRI) for liver cancer surveillance in cirrhotic patients has found MRI offers significant advantages, including earlier tumor detection and fewer false-positive referrals. These findings could influence surveillance protocols for at-risk patients.
The single-center study, conducted in South Korea, enrolled 414 participants aged 20–70 years with Child-Pugh class A cirrhosis and no history of liver malignancy. Participants were randomized to undergo semiannual surveillance with either US or noncontrast MRI, supplemented by alpha-fetoprotein (AFP) testing. Primary endpoints included detection rates of early-stage tumors (Barcelona Clinic Liver Cancer [BCLC] stage 0 or A), stage distribution at diagnosis, and false-positive referral rates.
Between June 2015 and November 2022, 23 patients in the US group and 25 in the MRI group were diagnosed with liver cancer. While overall detection rates for BCLC stage 0 or A tumors were similar between groups (8% for US versus 12% for MRI), significant differences emerged in tumor stage and referral outcomes.
"BCLC stage 0 tumors were more frequently identified in the MRI group compared to the US group (8% versus 3%), highlighting the earlier detection capability of MRI," the authors stated. Additionally, the MRI group demonstrated significantly fewer false-positive referrals (0.7% versus 3.1%, *P* < 0.001).
The findings suggest noncontrast MRI improves early-stage diagnosis and reduces unnecessary interventions, making it a superior alternative to US for cirrhotic patients. "These results support the use of non-contrast MRI as a better surveillance tool for cirrhotic patients at risk for hepatic malignancy," the study concluded.
Reference
Rhee H, Kim MJ, Kim DY, et al. Non-contrast magnetic resonance imaging versus ultrasonography for hepatocellular carcinoma surveillance: A randomized, single-center trial. Gastroenterology. Published online January 22, 2025. doi:10.1053/j.gastro.2024.12.035
