Background: Biannual ultrasound (US) is recommended for hepatocellular carcinoma (HCC) surveillance in patients with cirrhosis. However, US has limited sensitivity for early-stage HCC, particularly in overweight cohorts, where hepatic visualisation is often inadequate. Currently there are no robust imaging surveillance strategies in patients with inadequate US visualisation. We investigated the ability of non-contrast, abbreviated magnetic resonance imaging (aMRI) to adequately visualise the liver for HCC surveillance in patients with previously inadequate US. Methods: Patients undergoing US surveillance, where liver visualisation was inadequate (LI-RADS VIS-B and VIS-C), were prospectively recruited. Patients underwent non-contrast T2-weighted and diffusion-weighted aMRI. The images were reviewed and reported by an expert liver radiologist. Three independent, blinded radiologists assessed the aMRI visualisation quality using a binary score assessing five parameters (parenchymal definition, vascular definition, coverage of the liver, uniformity of liver appearance and signal-to-noise ratio). Results: Thirty patients completed the aMRI protocol. The majority (90%) had underlying cirrhosis and were overweight (93.3%), with 50% obese and 20% severely obese. A total of 93.3% of the aMRI scans were of satisfactory quality. Six patients (20%) had hepatic abnormalities detected with aMRI that were not seen on their US: one HCC, one haemangioma and three clinically insignificant lesions. For the aMRI visualisation quality assessment, the coverage of the liver, vascular definition and parenchymal definition were consistently rated to be of sufficient quality by all three radiologists. Conclusions: Non-contrast aMRI provided good visualisation of the liver and detection of abnormalities in patients with inadequate US. aMRI should be further explored in a larger, prospective study as an alternative surveillance strategy in patients with inadequate US.
背景：对于肝硬化患者，建议每半年进行一次超声（US）检查以监测肝细胞癌（HCC）。然而，超声对早期HCC的敏感性有限，尤其是在超重人群中，其肝脏可视化效果往往不理想。目前，对于超声可视化不佳的患者，尚无可靠的影像监测策略。本研究探讨了非对比剂、简化磁共振成像（aMRI）在既往超声可视化不佳的患者中，用于HCC监测时充分显示肝脏的能力。 方法：前瞻性招募了接受超声监测但肝脏可视化不佳（LI-RADS VIS-B和VIS-C）的患者。患者接受了非对比剂T2加权和弥散加权aMRI检查。图像由一位肝脏影像学专家审阅并出具报告。三位独立的盲法放射科医生使用二元评分法评估了aMRI的可视化质量，评估参数包括五个方面（实质清晰度、血管清晰度、肝脏覆盖范围、肝脏外观均匀性以及信噪比）。 结果：共有30名患者完成了aMRI检查方案。大多数患者（90%）患有基础肝硬化且超重（93.3%），其中50%为肥胖，20%为重度肥胖。总计93.3%的aMRI扫描质量令人满意。有6名患者（20%）通过aMRI检测到超声未发现的肝脏异常：1例HCC、1例血管瘤以及3例无临床意义的病变。在aMRI可视化质量评估中，所有三位放射科医生一致认为，肝脏覆盖范围、血管清晰度和实质清晰度这三项参数的质量均足够。 结论：对于超声可视化不佳的患者，非对比剂aMRI能提供良好的肝脏可视化效果并检测出异常。应在更大规模的前瞻性研究中进一步探索aMRI，将其作为超声可视化不佳患者的替代监测策略。
肿瘤(癌症)患者之家