Division of Gastroenterology, Department of Medicine, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand.
Ma Har Myaing Hospital, Yangon, Myanmar.
J Gastroenterol Hepatol. 2024 Oct;39(10):1969-1981. doi: 10.1111/jgh.16643. Epub 2024 Jun 20.
Hepatocellular carcinoma (HCC) constitutes the majority of liver cancers and significantly impacts global cancer mortality. While ultrasound (US) with or without alpha-fetoprotein is the mainstay for HCC surveillance, its limitations highlight the necessity for more effective surveillance tools. Therefore, this review explores evolving imaging modalities and abbreviated magnetic resonance imaging (MRI) (AMRI) protocols as promising alternatives, addressing challenges in HCC surveillance.
This comprehensive review delves into the evaluation and challenges of HCC surveillance tools, focusing on non-contrast abbreviated MRI (NC-AMRI) and contrast-enhanced abbreviated MRI protocols. It covers the implementation of AMRI for HCC surveillance, patient preferences, adherence, and strategies for optimizing cost-effectiveness. Additionally, the article provides insights into prospects for HCC surveillance by summarizing meta-analyses, prospective studies, and ongoing clinical trials evaluating AMRI protocols.
The opinions underscore the transformative impact of AMRI on HCC surveillance, especially in overcoming US limitations. Promising results from NC-AMRI protocols indicate its potential for high-risk patient surveillance, though prospective studies in true surveillance settings are essential for validation. Future research should prioritize risk-stratified AMRI protocols and address cost-effectiveness for broader clinical implementation, alongside comparative analyses with US for optimal surveillance strategies.
肝细胞癌（HCC）构成了大多数肝癌，并对全球癌症死亡率产生重大影响。虽然超声（US）联合或不联合甲胎蛋白是 HCC 监测的主要手段，但它的局限性突显了需要更有效的监测工具。因此，本综述探讨了不断发展的成像方式和简化的磁共振成像（MRI）（AMRI）方案，作为有前途的替代方案，以应对 HCC 监测中的挑战。
本综述深入探讨了 HCC 监测工具的评估和挑战，重点关注非对比简化 MRI（NC-AMRI）和对比增强简化 MRI 方案。它涵盖了 AMRI 在 HCC 监测中的实施、患者偏好、依从性以及优化成本效益的策略。此外，本文通过总结评估 AMRI 方案的荟萃分析、前瞻性研究和正在进行的临床试验，为 HCC 监测的前景提供了见解。
这些观点强调了 AMRI 对 HCC 监测的变革性影响，特别是在克服 US 局限性方面。NC-AMRI 方案的有希望的结果表明其在高危患者监测中的潜力，但在真实监测环境中的前瞻性研究对于验证至关重要。未来的研究应优先考虑风险分层的 AMRI 方案，并解决更广泛临床实施的成本效益问题，同时进行与 US 进行的比较分析，以制定最佳监测策略。
