Hep C Discussion Forum

There is no doubt that SVR decreases the risk of hepatocellular carcinoma(HCC), with some studies suggesting by up to a factor of 10.  However, most Hepatologists agree that long-term followup is required, to detect early and potentially curable HCC.  AFP measurement is not specific enough so some form of liver imaging is required. For cirrhotics with SVR, the traditional followup was to have an AFP and a liver ultrasound every 6 months. Many think that F3 and F3-4 patients should also be included.

The recent Radiology journals are full of papers on early HCC detection. This is due to the rapid increase of HCC, mostly due to HCV patients. This increase is expected to continue for the next few years. Ultrasound is good for detecting suspicious lesions as small as 10 mms, but is non-specific. There are also limitations due to patient habitus and operator skills.  The general consensus is that MRI is superior to Ultrasound, CT, and Nuclear Medicine.  In last month's Australian Journal of Radiology, MRI sequences were explained using the latest liver-specific contrast agents, that could reliably recognise HCC's of 5mms in diameter, even in a cirrhotic liver. The vascular pattern is very important.  Up until now, there was great difficulty differentiating between a regenerating nodule (in cirrhotics) and a small HCC. This is very important in Rx options. The doubling (of size) time for an HCC is between 6 and 12 months. Surgical resection is the Rx of choice for such small lesions, and can result in a >70% 5 year survival.  

This is all very well and good in theory, but in practice, a 6 monthly MRI will be dismissed as being too expensive. In my case, I will be having a 6 monthly Ultrasound, and a yearly MRI.  I am difficult to ultrasound, having a high R diaphragm and prominent lower ribs. I have a 14 mm haemangioma in segment 2 of the L. liver lobe, which is impossible to see on ultrasound, but lights up like a Christmas tree on MRI ( and CT).  I urge all SVR patients who are F3 or worse, to ask their Hepatologist whether a yearly MRI is a good option, rather than just relying on 6 monthly Ultrasounds. Cost will be a factor ( as always).   Cheers.