Department of Radiology, Hopital Beaujon, APHP.Nord, Clichy, France.
Université Paris Paris, CRI, INSERM, Paris, France.
Hepatology. 2023 Aug 1;78(2):670-686. doi: 10.1097/HEP.0000000000000339. Epub 2023 Mar 13.
Current recommendations for the surveillance of HCC are based on the semiannual liver ultrasound (with or without serum alpha-fetoprotein) in patients with cirrhosis and in subgroups with chronic hepatitis B infection. However, the sensitivity of this strategy is suboptimal for the detection of early-stage tumors, especially in obese patients, due to interoperator variability and poor adherence. The detection rate of focal liver lesions is excellent with MRI, making it the best alternative candidate for surveillance. However, performing a full contrast-enhanced MRI is unrealistic because of limited availability and health economics. Abbreviated MRI (AMRI) corresponds to the acquisition of a limited number of sequences with a high detection rate. The theoretical benefits of AMRI are a reduced acquisition time (≤10 min) with improved time-effectiveness and cost-effectiveness compared with conventional MRI, and greater accuracy than ultrasound. Numerous protocols may be performed, including T1-weighted, T2-weighted, and DWI sequences, with or without contrast administration. Although published studies report promising per-patient results, they should be interpreted with caution. Indeed, most studies were simulated, retrospectively reviewing a subset of sequences in relatively small populations who underwent a full MRI. They also included groups that were not representative of screening populations. In addition, most were published by Asian groups, with at-risk populations that were different from Western populations. There are no existing longitudinal studies that directly compare the different AMRI approaches or AMRI to ultrasound. Finally, it is possible that 1 approach will not fit all patients and that strategies should be tailored to the risk of HCC, in particular in relation to the cost and availability of AMRI. Several trials are ongoing to evaluate these questions.
目前，HCC 监测的建议基于肝硬化患者和慢性乙型肝炎感染亚组患者的半年一次的肝脏超声（伴或不伴血清甲胎蛋白）。然而，由于操作者间的差异和不规范操作，这种策略对早期肿瘤的检测敏感性并不理想，尤其是在肥胖患者中。MRI 对肝脏局灶性病变的检测率很高，是监测的最佳替代选择。然而，由于可用性和健康经济学的限制，进行完全增强 MRI 是不现实的。简化 MRI（AMRI）是指采集具有高检测率的有限数量序列。与传统 MRI 相比，AMRI 的理论优势在于采集时间更短（≤10 分钟），时间效益和成本效益更高，并且比超声更准确。可以进行多种方案，包括 T1 加权、T2 加权和 DWI 序列，可伴或不伴对比剂给药。尽管已发表的研究报告了有前景的每位患者的结果，但应谨慎解释。事实上，大多数研究都是模拟的，回顾性地分析了在接受完整 MRI 的相对较小人群中采集的一组序列。这些研究还包括了不能代表筛查人群的亚组。此外，大多数研究都是由亚洲研究组发表的，亚洲的高危人群与西方人群不同。目前尚无直接比较不同 AMRI 方法或 AMRI 与超声的纵向研究。最后，可能一种方法并不适合所有患者，策略应根据 HCC 的风险进行调整，特别是与 AMRI 的成本和可用性有关。目前正在进行几项试验来评估这些问题。
