ULTRASOUND VS. MRI IN HEPATOCELLULAR CARCINOMA: THE BATTLE FOR DIAGNOSTIC SUPREMACY

Abstract

Background: Hepatocellular carcinoma (HCC) is the most common primary malignancy of the liver, often arising in the setting of chronic liver disease and cirrhosis. Accurate imaging is critical for diagnosis, staging, treatment planning, and follow-up. Objective: To compare the diagnostic accuracy of Ultrasound and Magnetic Resonance Imaging in the diagnosis of hepatocellular carcinoma. Methodology: Published reports of comparing the diagnostic accuracy of Ultrasound with Magnetic Resonance Imaging in the diagnosis of hepatocellular carcinoma were identified by a systematic search of Google Scholar, PubMed, Research Gate, Springer and the Sci Hub, supplemented with citation tracking.  From 950 initially identified studies, only 27 studies met the inclusion criteria after screening and duplicate removal. These studies compared the diagnostic accuracy of Ultrasound and Magnetic Resonance Imaging in the detection and diagnosis of hepatocellular carcinoma, using standard statistical measures, typically at a 95% confidence level. Results: Ultrasound (US) and magnetic resonance imaging (MRI) are two pivotal non-invasive imaging modalities used in the detection and characterization of HCC. US is widely accessible, cost-effective, and commonly used for initial screening, especially in high-risk populations. However, its sensitivity can be limited, particularly for small or isoechoic lesions. MRI, on the other hand, provides superior soft tissue contrast and functional imaging capabilities, allowing for better lesion characterization and detection of smaller tumors. The integration of both modalities, especially when combined with contrast agents and dynamic imaging protocols, can significantly improve diagnostic accuracy and patient management. Ongoing advancements in imaging techniques and artificial intelligence applications are also contributing to early detection and improved outcomes in HCC care. Conclusion: This systematic review demonstrates that USG and MRI are complementary tools in the imaging of hepatocellular carcinoma. While ultrasound remains essential for surveillance, MRI stands out for its superior diagnostic accuracy and lesion characterization capabilities. The integration of both modalities offers an optimized approach for the early detection and management of HCC.