Patient centered HCC surveillance - complementary roles of ultrasound and CT/MRI

Area of Science:

• Hepatology and Oncology
• Medical Imaging
• Cancer Surveillance

Background:

• Hepatocellular carcinoma (HCC) is a significant global health concern, representing a leading cause of cancer mortality.
• In the U.S., HCC is the fastest-growing cause of cancer death, necessitating effective screening strategies.
• Current guidelines recommend semi-annual serum α-fetoprotein and ultrasound (US) screening for high-risk individuals.

Purpose of the Study:

• To explore the shift towards a patient-centered approach in HCC surveillance.
• To detail the implications of the new LI-RADS US Surveillance v2024 core.
• To discuss alternative imaging modalities for patients with suboptimal US quality.

Main Methods:

• Review of current clinical practice guidelines (AASLD 2023) and LI-RADS US Surveillance v2024 core.
• Analysis of the role of visualization scores in determining ultrasound quality.
• Evaluation of risk factors associated with poor US image quality.
• Assessment of alternative surveillance options: multiphasic CT, MRI, and abbreviated MRI protocols.

Main Results:

• The updated LI-RADS US Surveillance v2024 core introduces a visualization score to assess ultrasound quality.
• Identified risk factors can predict poor ultrasound image quality in HCC surveillance.
• Alternative imaging strategies like CT and MRI offer viable options when US is not optimal.

Conclusions:

• Transitioning to a patient-centered HCC surveillance model is crucial.
• The LI-RADS v2024 core and visualization scores enhance ultrasound quality assessment.
• Alternative imaging modalities ensure continuous surveillance for all high-risk patients.