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

• Published in: Egyptian Journal of Radiology and Nuclear Medicine Vol. 51; no. 1; pp. 102 - 7
• Main Authors: Ahmed, Nora Nabil Abdou, El Gaafary, Sahar Mohamed, Elia, Remon Zaher, Abdulhafiz, Essam Mohamed
• Format: Journal Article
• Language: English
• Published: Berlin/Heidelberg Springer Berlin Heidelberg 16.06.2020; Springer; Springer Nature B.V; SpringerOpen
• Subjects: Antiviral agents; Antiviral drugs; Cholangitis; Contingency tables; Contraindications; Diffusion-weighted MRI; Direct-acting antiviral; Expected values; Glycoproteins; Health aspects; Hepatitis C virus; Hepatocellular carcinoma; Imaging; Infection; Infections; Liver; Liver cancer; Liver cirrhosis; Magnetic resonance imaging; Males; Medical research; Medicine; Medicine & Public Health; Medicine, Experimental; Mortality; Nuclear Medicine; Patients; Radiology; Ultrasonic imaging; Ultrasound; World health; Hepatocellular carcinoma; Ultrasound; Diffusion-weighted MRI; Direct-acting antiviral
• ISSN: 0378-603X; 2090-4762
• DOI: 10.1186/s43055-020-00199-x

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.