screening for hepatocellular carcinoma

[Anton45]

What is the preferred screening test for hepatocelllar carcinoma in a hep C patient (aside from alphafetal protein): ultrasound, CT, or MRI?

[copyman]

you covered them all except a liver biopsy

[Mr Liver]

The latest recommended protocol is for cirrhotics to alternate a CT and ultrasound 6 months apart.
ML

[copyman]

I did read that recommended protocol. what is scary about that is if you don't have cancer after all the radiation from the frequent CT's you will probably end up getting it.

[Thomas D Schiano, MD]

there is a lot of operator dependence in the use of ultrasound.  contrast ultrasonography however is used with good results in Europe but not the same in the US.  Only patients with cirrhosis awith HCV need to be screened for HCC.  At our center we use CT scans and MRI with equal sensitivity.

[newleaf09]

Once HCV and cirrhosis are resolved, how long does your practice recommend monitoring for HCC?

[Mr Liver]

Perhaps I need to get relisted to get those MRIs. ;) I was receiving two CT scans per year and thankfully that was reduced, but I would certainly prefer the MRI in place of the US . At least they do use Doppler which yields other useful data. I will certainly inquire about although I have a hunch insurance may be involved somehow.Regards,ML

[copyman]

yes the insurance comapines may not pay for the MRI's. CT's are like a third of the cost of an MRI.

[susan400]

I just had my first abdominal MRI last week.  No results back yet.  I had just been getting ultrasounds every 6 mon. up until this point.  After listening to a talk from the Liver Meeting about alternating with other methods, I suggested it to my doctor. He was fine with it as long as the insurance would cover it.  Susan400

[Mr Liver]

Thanks for the reply. I think you may be right about the MRIs since they do cost much more. I am calling the center today just to see if I can switch, as the good doctor above is correct in the diagnostic superiority of MRI over US as you know.

As soon as the report on CT radiation was released (last year?) the center I'm at knocked it down to one per year which is fine by me . But with the doubling rate of HCC tumors such as it is, you don't want any longer in between than necessary for HCC screening that's for sure.
ML

[GrandOak]

I've been getting a CT once every 12 months, some places use MRI but it is my understanding that they are equally effective in tumor detection, which is what the scanning is primarily focused upon.

The scan is often coupled with an Endoscopy (for esophagial varice monitoring), but for those without varices I believe that it may be something which is only done every two years, which is same period for a bone density scan.

Of course, AFP and LFT test are done every 6 months with docotor visits, along with a MELD calculation.

[giddyup]

my doc alternates between MRI and sono gram on six month intervals. gratefully oxford covers the mri's.