Preoperative diagnosis with versus without MRI in resection for hepatocellular carcinoma

Although MRI has been considered one of the most sensitive diagnostic techniques for hepatocellular carcinoma (HCC), a clear-cut beneficial effect of the use of preoperative MRI remains unclear. We assessed whether preoperative MRI has a beneficial effect on outcomes in patients scheduled to undergo resection of HCC.

We evaluated 449 patients with 553 liver tumors. MRI was performed in 349 of these patients, but not in the other 100. Ultrasonography, dynamic CT, and angiography were performed in all patients. Diagnostic abilities and long-term outcomes were compared between patients who did and did not undergo MRI.

The MRI group (349 patients) had 419 liver tumors and the no MRI group (100 patients) had 134 tumors. Preoperatively, the size of the HCC did not differ between the MRI (median, 30 mm; range, 10-205) and the no MRI group (median, 34 mm; range, 10-175; P = .99). The diagnostic accuracy was 98% in the MRI group and 96% in the no MRI group. Recurrence-free survival rates at 5 years were 31% (95% CI, 20.9-42.5) in the no MRI group, compared with 26% (95% CI, 20.1-32.1) in the MRI (P = .45). Overall survival rates at 5 years were 57% (95% CI, 45.6-68.1) in the no MRI group and 60% (95% CI, 53.4-66.8) in the MRI group (P = .64). After analysis by propensity score matching in 100 pairs of patients, recurrence-free survival rates at 5 years were 31% (95% CI, 20.9-42.5) in the no MRI group, compared with 19% (95% CI, 10.3-30.9) in the MRI group (P = .54). Overall survival rates at 5 years were 57% (95% CI, 45.6-68.1) in the no MRI group and 57% (95% CI, 43.2-68.8) in the MRI group (P = .92).

MRI seemed to offer no beneficial impact on diagnostic abilities or long-term outcomes after resection for HCC and is thus of questionable value as a routine imaging modality when combined with CT and angiography clinical practice.