From the Liver Imaging Group, Department of Radiology, University of California San Diego, 9500 Gilman Dr, MC 0888, San Diego, CA 92093 (J.Y.A., G.M.C., M.T.B., C.B.S., K.J.F.); School of Medicine, Tufts University, Boston, Mass (M.A.P.); Department of Radiology, University of Texas Southwestern Medical Center, Dallas, Tex (B.T.); and Department of Radiology, Icahn School of Medicine at Mount Sinai, New York, NY (T.Y.).
Radiographics. 2020 Nov-Dec;40(7):1916-1931. doi: 10.1148/rg.2020200104.
To detect potentially curable hepatocellular carcinoma (HCC), clinical practice guidelines recommend semiannual surveillance US of the liver in adult patients at risk for developing this malignancy, such as those with cirrhosis and some patients with chronic hepatitis B infection. However, cirrhosis and a large body habitus, both of which are increasingly prevalent in the United States and the rest of the world, may impair US visualization of liver lesions and reduce the sensitivity of surveillance with this modality. The low sensitivity of US for detection of early-stage HCC contributes to delayed diagnosis and increased mortality. Abbreviated MRI, a shortened MRI protocol tailored for early-stage detection of HCC, has been proposed as an alternative surveillance option that provides high sensitivity and specificity. Abbreviated MRI protocols include fewer sequences than a complete multiphase MRI examination and are specifically designed to identify small potentially curable HCCs that may be missed at US. Three abbreviated MRI strategies have been studied: nonenhanced, dynamic contrast material-enhanced, and hepatobiliary phase contrast-enhanced abbreviated MRI. Retrospective studies have shown that simulated abbreviated MRI provides high sensitivity and specificity for early-stage HCC, mostly in nonsurveillance cohorts. If it is supported by scientific evidence in surveillance populations, adoption of abbreviated MRI could advance clinical practice by increasing early detection of HCC, allowing effective treatment and potentially prolonging life in the growing number of individuals with this cancer. RSNA, 2020.
为了检测潜在可治愈的肝细胞癌（HCC），临床实践指南建议对有发生这种恶性肿瘤风险的成年患者（如肝硬化患者和某些慢性乙型肝炎感染患者）进行半年一次的肝脏超声监测。然而，在美国和世界其他地区越来越普遍的肝硬化和巨大体型可能会影响超声对肝脏病变的可视化效果，并降低该方法监测的敏感性。超声检测早期 HCC 的敏感性较低，导致诊断延迟和死亡率增加。缩短的 MRI（一种专门用于早期 HCC 检测的 MRI 简化方案）已被提议作为替代监测选择，其具有较高的敏感性和特异性。缩短的 MRI 方案比完整的多期 MRI 检查包含的序列更少，专门用于识别在超声检查中可能遗漏的小的潜在可治愈的 HCC。已经研究了三种缩短的 MRI 策略：非增强、动态对比增强和肝胆期对比增强缩短的 MRI。回顾性研究表明，模拟缩短的 MRI 对早期 HCC 具有较高的敏感性和特异性，主要是在非监测队列中。如果在监测人群中得到科学证据的支持，采用缩短的 MRI 可以通过提高 HCC 的早期检测率来推动临床实践，从而实现有效治疗，并可能延长越来越多患有这种癌症的个体的生命。RSNA，2020 年。
