Seif El Dahan Karim, Yokoo Takeshi, Mendiratta-Lala Mishal, Fetzer David, Davenport Matthew, Daher Darine, Rich Nicole E, Yang Edward, Parikh Neehar D, Singal Amit G
The University of Texas Southwestern Medical Center, Dallas, USA.
University of Michigan-Ann Arbor, Ann Arbor, USA.
Abdom Radiol (NY). 2025 May;50(5):2097-2109. doi: 10.1007/s00261-024-04674-1. Epub 2024 Nov 15.
MRI is a potential alternative to ultrasound for hepatocellular carcinoma (HCC) detection. We evaluated the impact of ultrasound and dynamic abbreviated MRI (AMRI) exam quality on early-stage HCC detection.
We conducted a multicenter case-control study among patients with cirrhosis (cases with early-stage HCC per Milan Criteria; controls without HCC) who underwent both a liver ultrasound and dynamic contrast-enhanced (DCE) AMRI within 6 months in 2012-2019. Two radiologists performed independent, blinded interpretations of both exams for HCC detection and scored exam quality as no/mild, moderate, or severe limitations. Associations between exam quality, patient characteristics, and HCC detection were assessed by odds ratios (OR).
Of 216 cases and 432 controls, severe limitations were reported in 7% and 8% of ultrasounds and DCE-AMRIs, respectively. Severe limitations at ultrasound were associated with obesity (OR 2.08, 95%CI [1.32-3.32]) and metabolic dysfunction-associated steatotic liver disease (MASLD) (OR 1.98 [1.12-3.44]) but not for DCE-AMRI. Decompensated cirrhosis (Child-Pugh C) was associated with severe limitations for both ultrasound (OR 2.54 [1.37-4.58]) and DCE-AMRI (OR 3.96 [2.36-6.58]). Compared to exams with no/mild limitations, exams with severe limitations had lower sensitivity for ultrasound (79.6% vs. 21.7%, P < 0.001) and AMRI (86.1% vs. 50.0%, P = 0.001). In patients in whom ultrasound was severely limited, DCE-AMRI had significantly higher odds of early-stage HCC detection than ultrasound (OR 8.23 [1.25-54.02]).
HCC detection by DCE-AMRI may be preferred in patients with severe limitations at ultrasound due to obesity and MASLD. Both modalities remain limited for patients with decompensated cirrhosis, for whom alternative strategies may be needed.
磁共振成像（MRI）是肝细胞癌（HCC）检测中超声的一种潜在替代方法。我们评估了超声和动态简化MRI（AMRI）检查质量对早期HCC检测的影响。
我们在2012年至2019年期间对肝硬化患者（根据米兰标准诊断为早期HCC的患者为病例组；无HCC的患者为对照组）进行了一项多中心病例对照研究，这些患者在6个月内均接受了肝脏超声检查和动态对比增强（DCE）AMRI检查。两名放射科医生对这两项检查进行独立、盲法解读以检测HCC，并将检查质量评为无/轻度、中度或严重受限。通过比值比（OR）评估检查质量、患者特征与HCC检测之间的关联。
在216例病例和432例对照中，超声检查和DCE-AMRI检查分别有7%和8%报告存在严重受限情况。超声检查的严重受限与肥胖（OR 2.08，95%CI [1.32 - 3.32]）和代谢功能障碍相关脂肪性肝病（MASLD）（OR 1.98 [1.12 - 3.44]）相关，但与DCE-AMRI无关。失代偿期肝硬化（Child-Pugh C级）与超声检查（OR 2.54 [1.37 - 4.58]）和DCE-AMRI检查（OR 3.96 [2.36 - 6.58]）的严重受限均相关。与无/轻度受限的检查相比，严重受限的检查对超声（79.6%对21.7%，P < 0.001）和AMRI（86.1%对50.0%，P = 0.001）的敏感性较低。在超声检查严重受限的患者中，DCE-AMRI检测到早期HCC的几率显著高于超声（OR 8.23 [1.25 - 54.02]）。
对于因肥胖和MASLD导致超声检查严重受限的患者，DCE-AMRI检测HCC可能更具优势。对于失代偿期肝硬化患者，这两种检查方式仍然存在局限性，可能需要采取其他策略。
