Outline the barriers in hepatocellular carcinoma (HCC) screening. Demonstrate the performance of non-contrast magnetic resonance imaging (NC-MRI, including a T1/T2/DWI) or diffusion-weighted imaging only (DWI-MRI) for the assessment of HCC. Identify subgroups for which NC-MRI or DWI-MRI may be useful when compared to ultrasound.

Background HCC is a leading cause of cancer morbidity with approximately 854,000 new cases per year worldwide [1] but has a disproportionate number of deaths (>810,000 per year) compared with other cancers due to patients often presenting at an advanced stage, restricting management to palliative measures, thereby having a poor survival (5-year survival of <20%). In contrast, early-stage HCCs with curative treatments have better survival (5-year survival approximately 40%) [1,2]. Multiple international guidelines for HCC surveillance adopt 6-monthly ultrasound surveillance [3–7]. Ultrasound has many benefits...

Article and Study Selection: 4385 articles were found on the initial search. 22 articles were selected for data extraction after applying selection criteria 12 articles had extractable per-patient data 17 articles had extractable per-lesion data 19 were retrospective, three were prospective. Quality assessment of trials was conducted with the Quality Assessment of Diagnostic Accuracy of Studies (QUADAS-2) tool. 12 studies were deemed a low risk for bias. 10 studies were deemed a moderate risk for bias. No study deemed high risk for bias. Per-Patient Diagnostic...

Currently, no HCC surveillance guideline offers an abbreviated or non-enhanced approach to MRI-based surveillance, citing insufficient evidence. This meta-analysis demonstrates that NC-MRI (T2+DWI+-T1): Has a reasonable pooled sensitivity of 86.8% and specificity of 90.3% for HCC detection. The positive and negative LRs are moderate in their impact on post-test probability. These compare favorably to pooled ultrasound sensitivities that range from 59.3-84%, however caution is required as these reported cohorts are not matched. Subanalysis highlights potential advantages for MRI Cirrhotic patients did not have significantly reduced...

M. Chan: Nothing to disclose Y. R. Huo: Nothing to disclose N. Trieu: Nothing to disclose A. Mitchelle: Nothing to disclose J. George: Nothing to disclose E. He: Nothing to disclose A. U. Lee: Nothing to disclose J. Chang: Nothing to disclose J. Yang: Nothing to disclose

1. Global Burden of Disease Liver Ccancer Collaboration, Akinyemiju T, Abera S, Ahmed, et al. The burden of primary liver cancer and underlying etiologies from 1990 to 2015 at the global, regional, and national level: results from the global burden of disease study 2015. JAMA Oncol 2017;3:1683–1691. 2. Shah C, Mramba LK, Bishnoi R, et al. Survival differences among patients with hepatocellular carcinoma based on the stage of disease and therapy received: pre and post sorafenib era. J Gastrointest Oncol 2017;8:789–798. 3. Korean Liver Cancer...