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Multicenter Study
. 2025 May;50(5):2097-2109.
doi: 10.1007/s00261-024-04674-1. Epub 2024 Nov 15.

Exam quality of ultrasound and dynamic contrast-enhanced abbreviated MRI and impact on early-stage HCC detection

Karim Seif El Dahan  1 , Takeshi Yokoo  1 , Mishal Mendiratta-Lala  2 , David Fetzer  1 , Matthew Davenport  2 , Darine Daher  1 , Nicole E Rich  1 , Edward Yang  1 , Neehar D Parikh  2 , Amit G Singal  3
Affiliations
Multicenter Study

Exam quality of ultrasound and dynamic contrast-enhanced abbreviated MRI and impact on early-stage HCC detection

Karim Seif El Dahan et al. Abdom Radiol (NY). 2025 May.

Abstract

Purpose: 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.

Methods: 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).

Results: 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]).

Conclusions: 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.

Keywords: Abbreviated MRI; Cirrhosis; Detection; Hepatocellular carcinoma; Ultrasound.

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Conflict of interest statement

Declarations. Competing interests: Amit Singal has served as a consultant or on advisory boards for Bayer, FujiFilm Medical Sciences, Exact Sciences, Universal Dx, Glycotest, Roche, Freenome, Delfi, GRAIL, Genentech, AstraZeneca, Eisai, Exelixis, Boston Scientific, HistoSonics. Neehar Parikh has served as a consultant or on advisory boards for Bayer, FujiFilm Medical Sciences, Exact Sciences, Glycotest, and Freenome. Matthew Davenport is a consultant for Covera Health, Treasurer for the Society of Advanced Body Imaging, and receives royalties from Wolters Kluwer.Nicole Rich has served as consultant for AstraZeneca.David Fetzer has served on the advisor board for GE HealthCare and Philips Healthcare, and has active research agreements with GE HealthCare, Philips Healthcare, and Siemens Healthineers.Takeshi Yokoo has served on an advisory board of Guerbet and the speaker panels for Siemens Healthineers and Northwest Imaging, as well as active research agreements with Siemens Healthineers.

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