Risk factors and screening intervals are crucial for evaluating the cost effectiveness of abbreviated MRI in HCC screening

Risk stratification and early detection biomarkers for precision HCC screening

Hepatocellular carcinoma (HCC) mortality remains high primarily due to late diagnosis as a consequence of failed early detection. Professional societies recommend semi-annual HCC screening in at-risk patients with chronic liver disease to increase the likelihood of curative treatment receipt and improve survival. However, recent dynamic shift of HCC etiologies from viral to metabolic liver diseases has significantly increased the potential target population for the screening, whereas annual incidence rate has become substantially lower. Thus, with the contemporary HCC etiologies, the traditional screening approach might not be practical and cost-effective. HCC screening consists of (i) definition of rational at-risk population, and subsequent (ii) repeated application of early detection tests to the population at regular intervals. The suboptimal performance of the currently available HCC screening tests highlights an urgent need for new modalities and strategies to improve early HCC detection. In this review, we overview recent developments of clinical, molecular, and imaging-based tools to address the current challenge, and discuss conceptual framework and approaches of their clinical translation and implementation. These encouraging progresses are expected to transform the current "one-size-fits-all" HCC screening into individualized precision approaches to early HCC detection and ultimately improve the poor HCC prognosis in the foreseeable future.

3D magnetic resonance fingerprinting on a low-field 50 mT point-of-care system prototype: evaluation of muscle and lipid relaxation time mapping and comparison with standard techniques

OBJECTIVE

To implement magnetic resonance fingerprinting (MRF) on a permanent magnet 50 mT low-field system deployable as a future point-of-care (POC) unit and explore the quality of the parameter maps.

MATERIALS AND METHODS

3D MRF was implemented on a custom-built Halbach array using a slab-selective spoiled steady-state free precession sequence with 3D Cartesian readout. Undersampled scans were acquired with different MRF flip angle patterns and reconstructed using matrix completion and matched to the simulated dictionary, taking excitation profile and coil ringing into account. MRF relaxation times were compared to that of inversion recovery (IR) and multi-echo spin echo (MESE) experiments in phantom and in vivo. Furthermore, B₀ inhomogeneities were encoded in the MRF sequence using an alternating TE pattern, and the estimated map was used to correct for image distortions in the MRF images using a model-based reconstruction.

RESULTS

Phantom relaxation times measured with an optimized MRF sequence for low field were in better agreement with reference techniques than for a standard MRF sequence. In vivo muscle relaxation times measured with MRF were longer than those obtained with an IR sequence (T₁: 182 ± 21.5 vs 168 ± 9.89 ms) and with an MESE sequence (T₂: 69.8 ± 19.7 vs 46.1 ± 9.65 ms). In vivo lipid MRF relaxation times were also longer compared with IR (T₁: 165 ± 15.1 ms vs 127 ± 8.28 ms) and with MESE (T₂: 160 ± 15.0 ms vs 124 ± 4.27 ms). Integrated ΔB₀ estimation and correction resulted in parameter maps with reduced distortions.

DISCUSSION

It is possible to measure volumetric relaxation times with MRF at 2.5 × 2.5 × 3.0 mm³ resolution in a 13 min scan time on a 50 mT permanent magnet system. The measured MRF relaxation times are longer compared to those measured with reference techniques, especially for T₂. This discrepancy can potentially be addressed by hardware, reconstruction and sequence design, but long-term reproducibility needs to be further improved.