The Use of Non‐Contrast Abbreviated MRI for the Detection of Recurrent Hepatocellular Carcinoma in Postoperative Surveillance

BACKGROUND: MRI is sensitive for detecting hepatocellular carcinoma (HCC), but its routine use is hindered by low accessibility. PURPOSE: To evaluate the performance of non-contrast abbreviated MRI (NC-AMRI) alone and in combination with alpha-fetoprotein (AFP) and protein induced by vitamin K absence II (PIVKA-II) compared to a complete MRI protocol for intrahepatic recurrent HCC detection. STUDY TYPE: Retrospective. POPULATION: 190 patients (male = 167, mean age 56.7 ± 11.2 years) undergoing post-hepatectomy MRI surveillance, including 88 with recurrent HCCs. FIELD STRENGTH/SEQUENCE: T2-weighted fast spin echo (conventional and PROPELLER), diffusion-weighted imaging (DWI), and dynamic T1-weighted gradient echo sequences at 1.5 T and 3.0 T. ASSESSMENT: The NC-AMRI set consisted of T2WI and DWI data and was extracted from the complete MRI study. Three radiologists independently evaluated the presence of recurrent HCC in two separate reading sessions (NC-AMRI and complete MRI). Pairwise comparisons were then made among three strategies: a combination of NC-AMRI, AFP, and PIVKA-II; NC-AMRI alone; and complete MRI. STATISTICAL TESTS: The diagnostic performance of the three strategies was compared using a marginal logistic regression with generalized estimating equations and McNemar test. Significance level was p < 0.05. RESULTS: The sensitivity of NC-AMRI was not significantly different to that of complete MRI for detecting recurrent HCC (Reviewer 1: 94.3% vs. 95.5%, p = 0.655; Reviewer 2: 96.6% vs. 96.6%, p > 0.999; Reviewer 3: 95.5% vs. 94.3%, p = 0.655), including small and medium size HCCs (p > 0.999 for all comparisons). Adding tumor markers to NC-AMRI did not significantly improve HCC detection compared to NC-AMRI alone or complete MRI. DATA CONCLUSION: NC-AMRI demonstrated no significant difference in diagnostic performance compared to that of complete MRI in detecting intrahepatic recurrent HCCs, including small-sized lesions. Additionally, the incorporation of AFP and PIVKA-II did not significantly improve the diagnostic sensitivity of NC-AMRI. EVIDENCE LEVEL: 3. TECHNICAL EFFICACY: Stage 2.