Is MRI useful for checking liver cancer? There are three other auxiliary examination methods for liver cancer

A study by American scholars Snowberger et al. showed that magnetic resonance imaging (MRI) has the highest sensitivity in detecting hepatocellular carcinoma (HCC) and can determine the volume of HCC. Alpha-fetoprotein (AFp) is not sensitive enough for screening HCC, but AFp has predictive significance for the prognosis of liver disease.

The study included patients who underwent liver transplantation at the Baylor Regional Transplant Center and compared the correlation between the results of AFp, ultrasound, CT, MRI and other examinations they received and the diagnosis and prognosis.

The results showed that HCC lesions were confirmed in the liver tissue removed during liver transplantation in a total of 239 patients, of which 186 (77.8%) had been diagnosed with HCC before liver transplantation. 226 (94.6%) patients also had cirrhosis, and the primary causes of liver disease were mainly hepatitis C (55.2%), hepatitis B (16.7%), alcoholic liver disease (9.2%), and 18.9% were of unknown cause.

Among 239 HCC patients, 148 (61.9%) had elevated AFp levels, of which 26%, 15%, and 13% had AFp levels exceeding 100, 400, and 1000 ng/ml, respectively. AFp was elevated in 19.6% of non-HCC liver transplant patients, but only 3% had AFp levels exceeding 100 ng/ml. 199 (83.4%), 164 (68.6%), and 197 (82.4%) patients underwent ultrasound, CT, and MRI, respectively, of which 115 (57.8%), 113 (68.9%), and 153 (77.7%) had preoperative HCC, respectively. Among HCC patients with a single liver cancer lesion ≤2 cm, 38.1% had elevated AFp levels. By ultrasound, CT and MRI, HCC was detected in 34.9% (23/66 cases), 59.1% (26/44 cases) and 63.1% (41/65 cases) of patients, respectively. When a single liver cancer lesion was > 2 cm, HCC was detected in 69.2% (92/133 cases), 72.5% (87/120 cases) and 84.8% (112/132 cases) of patients, respectively.

With the development of technology, the HCC detection rate of MRI increased from 70.2% (59/84 cases) before 2000 to 83.2% (94/113 cases) after 2000, and the detection rate for lesions ≤2 cm increased from 40.0% to 73.3%.

Studies have shown that imaging examinations are more sensitive and effective than AFp in the detection of HCC, and MRI is more sensitive than ultrasound and CT examinations in the detection of small liver lesions.

The incidence of hepatocellular carcinoma is high in my country. In the past, AFp and ultrasound examination were important detection methods for screening and detecting early hepatocellular carcinoma. However, the results of this study showed that MRI is the most sensitive for detecting hepatocellular carcinoma and can best reflect the volume of hepatocellular carcinoma lesions. However, AFp detection is simple and inexpensive. Although it is not sensitive enough, it still has certain value when the level is increased.

Other auxiliary examinations

1. The most commonly used examination is liver ultrasound. Ultrasound examination is a non-invasive examination and has no adverse effects on human tissues. It is simple to operate, intuitive and accurate, low-cost, convenient and non-invasive, and widely popular. It can be used for the screening of liver cancer and follow-up after treatment.

2. CT has become an important routine means of diagnosing liver cancer. Abdominal enhanced CT scans can clearly show the size, number, shape, location, boundary, tumor blood supply, and relationship with the intrahepatic ducts of liver cancer, which is important for further clarifying the diagnosis and distinguishing it from other benign liver lesions. At the same time, it is also important to clarify the staging and grading of liver cancer, which is important for guiding treatment and judging prognosis. Image analysis software can also be used to reconstruct the various ducts in the liver, accurately track the course of blood vessels in each liver segment, the relationship between tumors and blood vessels, simulate the surgical resection plane, and calculate the volume of the pre-resected tumor and the remaining liver volume, greatly improving the safety of the operation.

3. pET (positron emission tomography)-CT whole-body scan can understand the overall condition and evaluate tumor metastasis, and can more comprehensively determine the tumor stage and prognosis, but it is relatively expensive and is generally not the first choice.