Hepatocellular Carcinoma Surveillance Imaging Techniques

Hepatocellular carcinoma surveillance relies on imaging modalities capable of early detection in at-risk populations such as patients with cirrhosis or chronic hepatitis. Ultrasonography remains the global standard due to accessibility, cost-effectiveness and safety. However, its operator dependence and reduced sensitivity in patients with obesity, hepatic steatosis or nodular architecture limit reliability. Cross-sectional techniques—including computed tomography and magnetic resonance imaging—offer superior lesion characterisation and reproducibility but carry trade-offs in radiation exposure, contrast risks and financial burden. Within MRI, protocols have evolved from comprehensive multiphase studies to abbreviated approaches (AMRI), combining a tailored subset of sequences to balance diagnostic performance with reduced acquisition time. Recent innovations include non-contrast AMRI augmented by serum biomarkers, dynamic contrast-enhanced abbreviated MRI and hepatobiliary phase imaging using liver-specific agents. Concurrently, artificial intelligence and deep learning tools are being developed to standardise lesion detection and classification, with the potential to streamline workflow and increase sensitivity for small or atypical tumours. Globally, these advances aim to refine surveillance algorithms, enhance early-stage detection rates and improve eligibility for curative therapies while maintaining accessibility across diverse healthcare settings.

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Hepatocellular Carcinoma Surveillance Imaging Techniques publication trend

The graph below shows the total number of articles in hepatocellular carcinoma surveillance imaging techniques across all publications each year (not limited to Nature Index journals).

Technical terms

Abbreviated MRI (AMRI): A shortened MRI protocol selecting key sequences to detect hepatocellular carcinoma more rapidly.

Non-contrast AMRI (NC-AMRI): AMRI performed without intravenous contrast agents, relying on T2-weighted and diffusion-weighted imaging.

Dynamic contrast-enhanced MRI (DCE-MRI): Imaging acquired after injection of extracellular contrast to assess lesion vascularity during arterial and portal phases.

Alpha-foetoprotein (AFP): Serum biomarker often elevated in hepatocellular carcinoma, used adjunctively in surveillance.

Hepatobiliary phase (HBP): Late phase of contrast-enhanced MRI using hepatocyte-specific agents to improve lesion detection and characterisation.

Diffusion-weighted imaging (DWI): MRI technique sensitive to the motion of water molecules, highlighting tumour cellularity by restricted diffusion.

Artificial intelligence (AI): Computational algorithms, including deep learning, used to automate analysis and interpretation of imaging data.

Sensitivity and specificity: Statistical measures of a test’s ability to correctly identify true positives and true negatives, respectively.

LI-RADS: Liver Imaging Reporting and Data System; a standardised framework for categorising liver lesions in at-risk patients.

References

1. The combination of non-contrast abbreviated MRI and alpha foetoprotein has high performance for hepatocellular carcinoma screening. European Radiology (2023).
2. Meta-Analysis of the Accuracy of Abbreviated Magnetic Resonance Imaging for Hepatocellular Carcinoma Surveillance: Non-Contrast versus Hepatobiliary Phase-Abbreviated Magnetic Resonance Imaging. Cancers (2021).
3. Gadoxetate-enhanced Abbreviated MRI for Hepatocellular Carcinoma Surveillance: Preliminary Experience. Radiology Imaging Cancer (2019).
4. Deep Learning Algorithm for Differentiating Patients with a Healthy Liver from Patients with Liver Lesions Based on MR Images. Cancers (2023).
5. Ultrasound or Sectional Imaging Techniques as Screening Tools for Hepatocellular Carcinoma: Fall Forward or Move Forward?. Journal of Clinical Medicine (2021).