How accurate are Magnetic Resonance Imaging (MRI) scans for detecting liver cancer?

Key messages

In people with chronic liver disease, magnetic resonance imaging (MRI: scans across the body) probably misses liver cancer in 16% of people, who would not receive a timely or appropriate treatment, and incorrectly detects liver cancer in 6% of people, who would receive unnecessary treatment.

MRI likely misses liver cancer in 16% of people with liver cancer who could have surgery to remove part of their liver, and incorrectly detects liver cancer in 7% people who undergo inappropriate surgery.

The studies were at high risk of bias and were too different from each other to allow us to draw firm conclusions based on the evidence.

Why is it important to accurately diagnose liver cancer?

Liver cancer, or “hepatocellular carcinoma”, mainly occurs in people with chronic liver disease from any cause. It is the sixth most common cancer in the world and the third leading cause of cancer death. It is difficult to diagnose because the first symptoms are similar to those of liver disease. People whose blood test or ultrasound results suggest liver cancer may have other tests, such as scans that produce images of the liver or a biopsy where a small piece of liver is removed and examined. If liver cancer is caught early, people can be treated with surgery to remove part of the liver (called liver resection) or with a liver transplant. If the liver cancer is more advanced, they may need chemotherapy. If liver cancer is not detected during the diagnostic test, people will not receive the appropriate treatment. However, misdiagnosis of liver cancer when it is not present means people may undergo unnecessary testing or treatment.

What is magnetic resonance imaging (MRI) and how can it diagnose liver cancer?

MRI produces images that show a cross section or “slice” of bones, blood vessels and tissues inside the body. The images are a series of signal intensities directed and combined by a computer. MRI scans can detect the presence of abnormalities in the liver that could be cancerous. Current guidelines recommend using either MRI or another type of imaging, CT scan, or a combination to confirm the presence of liver cancer in people who are suspected of having liver cancer.

What did we want to find out?

We wanted to know if MRI is accurate enough to diagnose liver cancer in adults with chronic liver disease. We were first interested in liver cancers of all sizes and at all stages and then in liver cancers likely to be resected.

What have we done?

We searched for studies that assessed the accuracy of MRI scans against the best available tests for confirming liver cancer in adults with chronic liver disease. The best tests available are examination of the liver or part of the liver under a microscope.

What did we find?

We found 34 studies assessing 4841 people.

About 560 in 1,000 adults (56%) with chronic liver disease have confirmed liver cancer. Among these 1000 people, MRI can:

– correctly detect liver cancer in 473 people;

– miss liver cancer in 87 people;

– incorrectly detect liver cancer in 27 people without cancer;

– correctly detect any liver cancer in 413 people.

Based on the studies, approximately 560 out of 1000 (56%) adults with chronic liver disease have confirmed resectable liver cancer. Among these 1000 people, MRI can:

– correctly detect resectable liver cancer in 472 people;

– miss resectable liver cancer in 88 people;

– incorrectly detect resectable liver cancer in 31 people;

– correctly detect any resectable liver cancer in 409 people.

What are the limits of the evidence?

Our confidence in the evidence is limited because studies used different methods to select study participants and used different definitions of the presence of liver disease. This means that MRI scans could be more or less accurate than our analyzes of the evidence suggest.

How up-to-date is this evidence?

The evidence is current to November 9, 2021.

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