Magnetic Resonance Imaging-Based Surveillance of Hepatocellular Carcinoma: Current Status and Future Perspectives

We aimed to introduce various magnetic resonance imaging (MRI)-based hepatocellular carcinoma (HCC) surveillance strategies in high-risk patients from technical to clinical viewpoints and provide guidance on selecting patients who would benefit from MRI-based surveillance.

MRI has recently gained attention as an HCC surveillance tool due to its superior sensitivity in detecting early-stage HCC over ultrasonography (US). However, complete-sequence contrast-enhanced liver MRI has limitations of long scan time and high cost. Abbreviated MRI (AMRI) utilizes only the essential sequences for detecting HCC and has gained popularity for reduced scan time and cost while maintaining high diagnostic performance. Three AMRI protocols have been proposed, including hepatobiliary-phase, dynamic contrast-enhanced, and non-enhanced AMRI. Herein, technical details, result interpretation, performances based on previous work, ongoing trials, and current issues regarding each MRI protocol are discussed. For maximum benefits of MRI-based surveillance, a risk-stratified approach should be undertaken to select the target population, simultaneously considering cost-effectiveness. MRI-based HCC surveillance can be beneficial for populations whose US examination has inadequate quality. Evidence of cost-effectiveness of MRI-based surveillance for high-risk patients is growing.

MRI-based surveillance, particularly using AMRI, shows promise as a sensitive and cost-effective approach for early detection of HCC. Tailored approaches that take into account the patient’s HCC risk and the quality of ultrasonographic images can optimize the benefits of MRI-based surveillance. Further research is needed to assess the cost-effectiveness of MRI-based surveillance strategies.