Negative MRI Strongly Predicts Low One-Year HCC Risk

Observed HCC Rates Lower Than Expected

Varney and her team evaluated 131 patients with cirrhosis who had either a negative MRI, negative US, or both at baseline, and considered two study arms: MRI and US. Within each study arm, they assessed the rate of HCC diagnosis within one year of the exam.

In the MRI arm of 117 patients, no cases of HCC were detected within one year. In contrast five patients in the US subgroup (4.2%) were diagnosed with HCC during that same period. 

The researchers were particularly struck by two findings. “Firstly, prior studies have suggested a 2-3% annual incidence of HCC even after negative imaging, but this cohort demonstrated a 0.0% one-year cancer detection rate after negative MRI,” Varney said. “Secondly, 100% of the cancers identified in the US arm were present at baseline and detected by contemporaneous MRI.” 

Varney reinforced the significance of these findings. “All five HCC diagnoses came from cancers that were missed by ultrasound but detected by MRI,” she said.

The study also integrates the role of US visualization quality. All patients with negative US but positive MRI had limited US visualization (US-2 or US-3).

Varney noted that while poor visualization has long been recognized as a challenge in US-based surveillance, it remains debated whether poor US visualization should trigger reflex testing with MRI. The analysis suggests that poor visualization may be common even among patients who ultimately remain cancer negative.

“Roughly 80% of index ultrasounds in the HCC-negative group also rated US-2 or US-3, and further evaluation of these scores is ongoing,” she said.

Looking ahead, Varney shared that the team has expanded the study scope, with data collection ongoing at partner sites from the Focused Abbreviated Screening Technique (FAST)-MRI prospective trial. The multicenter trial involves the Icahn School of Medicine at Mount Sinai in New York, the University of California, San Diego, and the University of Wisconsin, Madison. They expect to triple the cohort size and develop a more nationally representative sample.

“Overall, our findings underscore the prognostic confidence provided by negative MRI,” Varney said. “If validated in larger cohorts, the data could support extending surveillance intervals, reducing patient burden and improving adherence—ultimately strengthening early HCC detection efforts in clinical practice.”

Access the session, “Detection of HCC One Year Following Negative MRI versus Negative Ultrasound,” on demand at RSNA.org/MeetingCentral.