MRI Outperforms Ultrasound in Detecting Liver Cancer During Cirrhosis Screening: Study Shows
USA: A study published in Radiology reports that gadoxetate-enhanced MRI provides superior image quality and screening sensitivity for hepatocellular carcinoma (HCC) compared with ultrasound in patients with cirrhosis. The research, led by Sara Lewis, MD, of the Icahn School of Medicine at Mount Sinai, highlights the potential advantages of MRI for surveillance in a population at high risk for liver cancer.
Ultrasound is currently the standard imaging tool for HCC surveillance. However, prior evidence has suggested that contrast-enhanced MRI—particularly with gadoxetate disodium—may detect tumors more effectively. Despite this, direct comparisons of image quality between ultrasound and MRI in routine screening settings have been limited.
To explore this gap, Lewis and colleagues conducted a secondary analysis of a prospective, two-center North American HCC screening study performed between September 2020 and May 2023. The analysis included 245 adults with cirrhosis who underwent both liver ultrasound and gadoxetate-enhanced MRI as part of their surveillance.
Two independent radiologists reviewed MRI examinations for motion during dynamic contrast phases, adequacy of hepatobiliary phase liver uptake, and diffusion-weighted imaging quality. Based on these parameters, scans were categorized as MR-A (no or minimal limitations), MR-B (moderate limitations), or MR-C (severe limitations). Ultrasound studies were graded using the Liver Imaging Reporting and Data System visualization score: US-A (no or minimal limitations), US-B (moderate limitations), and US-C (severe limitations).
The findings showed a clear difference in image quality distribution:
- Among MRI examinations, 80.4% were classified as MR-A (no or minimal limitations), 18.4% as MR-B (moderate limitations), and 1.2% as MR-C (severe limitations).
- For ultrasound, 24.2% of scans were graded US-A, 61.7% US-B, and 14.1% US-C.
- Overall, 98% of MRI scans showed no, minimal, or moderate limitations compared with 86% of ultrasound exams, a statistically significant difference.
- Nearly 79% of participants with moderate or severe ultrasound limitations still demonstrated excellent MRI quality.
- Conversely, 81% of individuals with moderate or severe MRI limitations also had poor-quality ultrasound examinations.
- Obesity (body mass index ≥ 30) was associated with reduced image quality for both modalities on univariable analysis, with an odds ratio of 4.2 for MRI and 2.5 for ultrasound.
- A Child-Pugh class B or C score was linked to decreased MRI quality in both univariable and multivariable analyses, with an adjusted odds ratio of 3.95.
The authors note that image quality scores must be interpreted in the context of the clinical task. Ultrasound remains a primary screening tool, while MRI is generally considered diagnostic. Nonetheless, the data suggest that MRI offers more consistently high-quality imaging in cirrhosis, even when ultrasound performance is limited.
The researchers emphasize that these scoring frameworks may serve as a foundation for future investigations aimed at optimizing HCC surveillance strategies in high-risk populations.
Reference:
Lewis S, Wildman-Tobriner B, Cuevas J, Calle S, Bolger I, Wang K, Joshi H, Mankowski Gettle L, Yang JD, Min JH, Sirlin CB, Reeder SB, Bashir MR, Taouli B. Quality of Gadoxetate-enhanced MRI versus US during Hepatocellular Carcinoma Screening in Participants with Cirrhosis. Radiology. 2026 Feb;318(2):e251497. doi: 10.1148/radiol.251497. PMID: 41665498.
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