Role of abbreviated MRI protocol for screening of HCC in HCV related cirrhotic patients prior to direct-acting antiviral treatment

Abstract

Background: Chronic HCV infection is a global health problem causing progressive hepatic fibrosis, cirrhosis, and ultimately hepatocellular carcinoma (HCC). Recent advantage of direct-acting antiviral drugs (DAA) with a high sustained virologic response (SVR) reduces overall HCV-related morbidity and mortality, yet recent studies report a high recurrence rate of HCC after DAA; this calls availability of a reliable screening method to properly exclude HCC before DAA treatment. The primary objective of our cohort study was to assess the feasibility of an abbreviated MRI protocol as a screening tool for the detection of hepatic focal lesions/early HCC in patients with HCV-related liver cirrhosis. The study included 41 patients with HCV-related cirrhosis candidates to DAA therapy. All patients underwent routine screening for HCC by combined abdominal ultrasound and serum alfa-fetoprotein. An abbreviated MRI protocol (Abr-MR) including combined T2-weighted image and diffusion-weighted imaging (DWI) followed by dynamic contrast-enhanced MRI (CE-MRI) was performed for all subjects, assessing for presence and characterization of focal lesions. Results: For all included 41patients, no elevation of the alpha-fetoprotein was shown. Ultrasound detected a single focal lesion in one patient. Abbreviated MR demonstrated 15 focal lesions; for detected lesions, 1 lesion shows “shine though” and the rest showing moderate and high degrees of restriction. CE-MRI characterized lesions as 1 lesion = LIRADS-1, 3 lesions = LR-M, and 11 lesions = LR-5.The standard screening using combined ultrasound and alpha-fetoprotein had sensitivity, specificity, PPV, and NPV of 6.6 % (95% CI = 0.0034–0.29), 100% (95% CI = 0.89–1.000), 100% (95% CI = 0.051–1.000), and 68.8% (95% CI = 0.54–0.80). Abr-MR protocol showed sensitivity, specificity, PPV, and NPV of 100% for all parameters (95% CI = 0.79–1.000, 0.89–1.000, 0.79–1.000, and 0.89–1.000 respectively). Conclusion: In our study, we demonstrate the superiority of a proposed cost-effective Abr-MR protocol in the detection of hepatic focal lesions and small-sized HCC compared to routine screening using alpha-fetoprotein and ultrasound in HCV-related liver cirrhosis.