Hepatocyte-specific Versus Extracellular Contrast Agents for Liver MRI: Prospective, Intra-individual Comparison of Diagnostic Performance for Hepatocellular Carcinoma
Hepatocyte-specific Versus Extracellular Contrast Agents for Liver MRI: Prospective, Intra-individual Comparison of Diagnostic Performance for Hepatocellular Carcinoma
Adult patients with chronic hepatitis B and cirrhosis of any etiology who are found to have
 suspected liver cancer are potentially eligible for the study. All enrolled patients will
 undergo two MRI scans using two different contrast agents. The type of contrast agent for the
 1st MRI will be performed using hepatocyte-specific contrast agent. The participant will
 undergo the 2nd MRI using extracellular contrast agent. The MRI examinations will be
 independently interpreted by two different radiologists. The radiologists will evaluate focal
 hepatic lesions and categorize them according to the LI-RADS v2018 and EASL 2018. Once the
 diagnosis is made, the participants will be provided with the standard of care. After the
 initial treatment, the participants will be followed up with multi-phasic dynamic
 contrast-enhanced CT every 3 or 6 months for at least 2 years. Based on the prospectively
 written radiology reports, the diagnostic performances will be calculated and compared
 between MRI with hepatocyte-specific contrast agent and MRI with extracellular contrast
 agent, using the pathology and clinical criteria as the reference standard.
Inclusion Criteria:

 1. Older than 20 years

 2. HBsAg (+) with chronic hepatitis or cirrhosis, anti-HCV (+) with cirrhosis, or
 cirrhosis of any etiology

 -  The presence of cirrhosis will be determined based on the histologic or
 radiologic findings, including liver surface nodularity, margin blunting,
 segmental hypertrophy/atrophy, and findings secondary to portal hypertension
 (i.e., splenomegaly, esophageal or gastric varices, ascites, or reverse portal
 vein flow).

 3. Child-Pugh class A or B

 4. Up to three suspicious focal lesions between 10 mm and 30 mm found on US, CT, or MRI

 -  Patients with a history of HCC treated by surgery or tumor ablation could be
 included, but only new nodules at a distance of > 2 cm from previously treated
 lesions were considered.

 Exclusion Criteria:

 1. Currently pregnant or lactating

 2. Risk group for the use of gadolinium-enhanced MRI including severely decreased renal
 function (stage 4 or 5 chronic renal failure with eGFR ˂ 30 mL/min/1.73 m2),
 claustrophobia

 3. Patients with history of chemoembolization or systemic treatment for liver cancer