Role of abbreviated MRI protocol for screening of HCC in HCV related cirrhotic patients prior to direct acting antiviral treatment

Abstract

hronic HCV infection is a global health problem that affects millions of people worldwide. International guidelines for screening of HCC in cirrhotic patients suggest an ultrasound every six months as the first level of investigation. The main goal is diagnosing early HCC/dysplastic nodule, however, such a goal remains difficult due to the low sensitivity of such protocol (60%). HCC is unique in having imaging characteristics on contrast-enhanced computed tomography (CE-CT) or contrast-enhancing magnetic resonance imaging (CE-MRI) allowing for its accurate diagnosis. This primarily depends on the enhancement criteria of the suspected lesion relative to background liver in the hepatic arterial, portal venous, and subsequent phases. Hence, CE-CT/ CE-MRI are most widely used for characterizing HCC in patients with cirrhosis. This is due to the increased ability of arterial phase enhancement to visualize early, small lesions. Although the sensitivity of helical CT for depicting hepatocellular carcinoma in patients with cirrhosis has been well documented to be from 50% to 70%, CE-MRI has shown higher figures of sensitivity and specificity for HCC detection and characterization especially for early/small-sized HCC. However, MRI examinations have limited accessibility; high cost, long scan time and the risk of contrast related side effects. However when performed without the use of contrast agents, the risk of contrast-related adverse events is eliminated, and both the cost and examination time can be reduced. With this in mind, non-contrast MRI is potentially a good alternative surveillance tool for HCC.