Non-contrast abbreviated MRI rescued HCC surveillance when ultrasound could not see the liver

Design

Retrospective single-centre cohort

Population

264 Child-Pugh A/B cirrhotic patients with prior ultrasound VIS-C

Primary outcome

Visualisation quality on NC-AMRI and early-stage HCC detection

Effect

Adequate views 91.7% (DWI), 95.1% (T2WI); 17 of 18 HCCs early stage

LI-RADS 2024 surveillance guidance allows abbreviated MRI for patients whose ultrasound visualisation score is C, meaning severe limitation. This retrospective Korean study examined 264 Child-Pugh A or B cirrhotic patients with a previous VIS-C ultrasound who then had non-contrast abbreviated MRI (diffusion and T2-weighted images).

Visualisation was adequate (score A or B) in 91.7% on diffusion-weighted imaging and 95.1% on T2-weighted imaging. Of 18 hepatocellular carcinomas detected, 17 (94.4%) were early stage.

Poor ultrasound windows from obesity, fatty liver or coarse cirrhotic texture leave many patients with surveillance that cannot find small tumours. A short, contrast-free MRI is a practical alternative that preserves the purpose of surveillance.

The evidence is a single-centre retrospective series without a comparison group, so it shows feasibility rather than superior outcomes.

• Record the ultrasound visualisation score (A, B or C) in every HCC surveillance report.
• After a VIS-C examination, recommend an alternative such as abbreviated MRI rather than repeating ultrasound.
• A non-contrast protocol avoids gadolinium and shortens table time.
• Keep diffusion-weighted imaging in the protocol; it was the more limited sequence and the key one for detection.

Why it matters

Repeating an ultrasound that cannot see the liver gives false reassurance to exactly the patients at risk of a missed cancer.

Don't overread it

This retrospective single-centre series had no ultrasound or full MRI comparison, so it cannot show better survival or detection rates.

The statistics, in plain English

Eighteen cancers is a small number, so the 94.4% early-stage figure has wide uncertainty. Visualisation adequacy is a quality measure, not a measure of how many cancers were missed.

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