MRI Abdomen MRI of the abdomen without and with IV contrast is highly sensitive for detecting HCC recurrence. Multiple contrast mechanisms (perfusion, diffusion, hepatobiliary agent uptake, intrinsic T1- and T2-weighted signal intensity) can be used for assessment; however, arterial phase hyperperfusion remains the mainstay for detection of HCC recurrence. Both the National Comprehensive Cancer Network and the European Association for the Study of the Liver recommend CT or MRI at regular intervals for at least 2 years for follow-up of patients with treated HCC [77]. The role of hepatobiliary MRI in this setting remains controversial. It has been shown to increase sensitivity for detection of small lesions, but may overdiagnose premalignant lesions [78]. In addition, imaging artifacts are more common with gadoxetate disodium, the primary agent used for hepatobiliary imaging, and use of hepatobiliary agents may reduce the yield of the early perfusion assessment of lesions [57]. Because the detection and characterization of HCC relies mainly on the perfusional features of liver lesions, MRI without IV contrast is not typically performed for this purpose. However, noncontrast MRI may be a reasonable modality for surveillance, because it offers the best differentiation between types of soft tissues of the available noncontrast modalities. Chronic Liver Disease US Abdomen Because of the importance of vascular perfusion and the absence of morphological changes in early HCC recurrence, US is not typically utilized as the only surveillance modality for assessing for recurrent HCC following treatment. The European Association for the Study of the Liver recommends multiphase CT or MRI to assess response 1 month after resection or locoregional or systemic therapies, followed by one imaging technique every 3 months to complete at least 2 years, and then regular US every 6 months thereafter [77].
Chronic Liver Disease. MRI Abdomen MRI of the abdomen without and with IV contrast is highly sensitive for detecting HCC recurrence. Multiple contrast mechanisms (perfusion, diffusion, hepatobiliary agent uptake, intrinsic T1- and T2-weighted signal intensity) can be used for assessment; however, arterial phase hyperperfusion remains the mainstay for detection of HCC recurrence. Both the National Comprehensive Cancer Network and the European Association for the Study of the Liver recommend CT or MRI at regular intervals for at least 2 years for follow-up of patients with treated HCC [77]. The role of hepatobiliary MRI in this setting remains controversial. It has been shown to increase sensitivity for detection of small lesions, but may overdiagnose premalignant lesions [78]. In addition, imaging artifacts are more common with gadoxetate disodium, the primary agent used for hepatobiliary imaging, and use of hepatobiliary agents may reduce the yield of the early perfusion assessment of lesions [57]. Because the detection and characterization of HCC relies mainly on the perfusional features of liver lesions, MRI without IV contrast is not typically performed for this purpose. However, noncontrast MRI may be a reasonable modality for surveillance, because it offers the best differentiation between types of soft tissues of the available noncontrast modalities. Chronic Liver Disease US Abdomen Because of the importance of vascular perfusion and the absence of morphological changes in early HCC recurrence, US is not typically utilized as the only surveillance modality for assessing for recurrent HCC following treatment. The European Association for the Study of the Liver recommends multiphase CT or MRI to assess response 1 month after resection or locoregional or systemic therapies, followed by one imaging technique every 3 months to complete at least 2 years, and then regular US every 6 months thereafter [77].