Contrast-enhanced MRI for Hepatocellular Carcinoma Assessment: Advances in Contrast Agents and Immunotherapy

Magnetic resonance imaging (MRI) has evolved into an important tool for the diagnosis and monitoring of hepatocellular carcinoma (HCC), with recent technological advances significantly enhancing its clinical utility. This review summarizes recent developments in MRI for HCC assessment, focusing on contrast agents and emerging applications in immunotherapy. We discuss the innovations in contrast agents for contrast-enhanced MRI in HCC surveillance, including gadolinium-based agents, iron oxide nanoparticles, and manganese-based alternatives, highlighting their specific advantages and limitations. Furthermore, we summarized the role of MRI in immunotherapy, including its ability to assess the tumor microenvironment and monitor treatment response. By summarizing the relationship between Wnt/β-catenin signaling and organic anion transporting polypeptide expression, as well as their corresponding HCC biological characteristics and contrast-enhanced MRI imaging features, a connection between HCC biological characteristics and MRI imaging features was demonstrated, providing new pathways to guide HCC immunotherapy. Although recent advancements hold promise, several key challenges warrant further consideration: the potential adverse effects of contrast agents, cost-effectiveness evaluation, limited accessibility of advanced imaging techniques, and difficulties in implementing standardized protocols across clinical settings, all of which require further validation in real-world settings. Addressing these challenges is crucial for realizing the full potential of MRI for HCC diagnosis and treatment.