What the Hepatologists, Liver Surgeons & GI Oncologists Want To Know
Yong Eun Chung1
1Yonsei University, Korea, Republic of

Synopsis

Keywords: Body: Liver

MRI plays a crucial role in the management of liver cancer as a tool for screening, diagnosis, treatment planning and surgical guidance. In addition, in patients with NAFLD, which has emerged as a significant concern in recent years, MRI with MR elastography can accurately assess the hepatic steatosis and fibrosis in the liver.

In the context of chronic liver disease, the initial step in patient management involves the screening for hepatocellular carcinoma (HCC). Periodic US and serological testing of high-risk patients is currently the most widely used method. Nevertheless, US is not deemed sufficiently accurate, with a sensitivity of approximately 61% and a specificity of 92%. Recently, there have been studies aimed at screening for HCC using abbreviated MRI of various protocols and have reported a higher sensitivity for detecting HCC at an early stage compared to US-based surveillance. Upon detection of a liver lesion, the diagnosis of HCC can be made based on imaging findings alone, without the need for tissue confirmation, making imaging diagnosis critical. If the imaging findings suggest a high likelihood of HCC, the number, size, and vascular invasion of the tumor are assessed to determine the tumor stage, and the treatment plans are made accordingly. As there are various treatment options for HCC, MRI is a useful tool for assessing the effectiveness of treatment. In patients who are candidates for surgical resection, surgeons can use MRI to identify lesions that are not visible on CT or ultrasound. In addition, in cases of liver transplantation, it is essential to assess the degree of hepatic steatosis in the donor. This assessment can be made by measuring PDFF, as it has a significant impact on post-transplant prognosis. Furthermore, as the anatomy of the bile ducts is crucial in determining the anastomosis method during the surgery, MRCP should be performed for assessment. Moreover, in patients with NAFLD, which has emerged as a significant concern in recent years, MRI with MR elastography can accurately assess the hepatic steatosis and fibrosis in the liver. MRI is also used to evaluate response to treatment. In addition to primary liver cancer, the liver is a frequent site for metastases from extrahepatic cancers, and MR can be used to evaluate liver metastases, providing a more accurate diagnosis than CT.

Acknowledgements

No acknowledgement found.

References

1.Itani M, Lalwani N, Anderson MA, Arif-Tiwari H, Paspulati RM, Shetty AS: Magnetic resonance cholangiopancreatography: pitfalls in interpretation. Abdom Radiol (NY) 2023, 48(1):91-105.

2.Diagnosis of Hepatocellular Carcinoma with Gadoxetic Acid-Enhanced MRI: 2016 Consensus Recommendations of the Korean Society of Abdominal Radiology. Korean J Radiol 2017, 18(3):427-443.

3.Kalor A, Girometti R, Maheshwari E, Kierans AS, Pugliesi RA, Buros C, Furlan A: Update on MR Contrast Agents for Liver Imaging: What to Use and When. Radiol Clin North Am 2022, 60(5):679-694.

4.Low G, Ferguson C, Locas S, Tu W, Manolea F, Sam M, Wilson MP: Multiparametric MR assessment of liver fat, iron, and fibrosis: a concise overview of the liver "Triple Screen". Abdom Radiol (NY) 2023, 48(6):2060-2073.

5.Reig M, Forner A, Rimola J, Ferrer-Fàbrega J, Burrel M, Garcia-Criado Á, Kelley RK, Galle PR, Mazzaferro V, Salem R et al: BCLC strategy for prognosis prediction and treatment recommendation: The 2022 update. J Hepatol 2022, 76(3):681-693.

6.Singal AG, Llovet JM, Yarchoan M, Mehta N, Heimbach JK, Dawson LA, Jou JH, Kulik LM, Agopian VG, Marrero JA et al: AASLD Practice Guidance on prevention, diagnosis, and treatment of hepatocellular carcinoma. Hepatology 2023, 78(6):1922-1965.

7.Weingärtner S, Desmond KL, Obuchowski NA, Baessler B, Zhang Y, Biondetti E, Ma D, Golay X, Boss MA, Gunter JL et al: Development, validation, qualification, and dissemination of quantitative MR methods: Overview and recommendations by the ISMRM quantitative MR study group. Magn Reson Med 2022, 87(3):1184-1206.

Proc. Intl. Soc. Mag. Reson. Med. 32 (2024)