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Brunsing et al. Hepatoma Res 2020;6:59 I http://dx.doi.org/10.20517/2394-5079.2020.50 Page 13 of 16

KEY POINTS
There are three variations of AMRI for HCC surveillance (non-contrast, dynamic, and hepatobiliary), each
offering unique advantages.

There is a growing body of literature suggesting the sensitivity of AMRI may be higher than US, however
existing data does not yet support widespread adoption of AMRI-based HCC surveillance by international
guidelines.

Current utilization of AMRI should focus on patients in whom US-based HCC surveillance is compromised.

Clinical trials directly comparing AMRI to US for HCC surveillance in high-risk populations are underway.

Continued evolution of MRI technology is expected to increase the robustness of AMRI for HCC detection.

RECOMMENDATION
We cautiously recommend AMRI in situations where US is compromised. With regard to the exact
approach - NC-AMRI, Dynamic-AMRI, or HBP-AMRI - all are reasonable. There is not yet sufficient
evidence to recommend one approach over another. Hence, we leave protocol selection to the individual
radiologist, referrer, and institution, considering patient preferences.

DECLARATIONS
Authors’ contributions
Made substantial contributions to structure and content of the text and figures: Brunsing RL, Fowler KJ,
Yokoo T, Cunha GM, Sirlin CB, Marks RM
Made substantial contributions to synthesizing edits from all authors: Brunsing RL

Availability of the data and materials
Not applicable.

Financial support and sponsorship
Dr. Sirlin's research is supported in part by NIH (1R01CA249765-01). The content is solely the responsibility of
the authors and does not necessarily represent the official views of the National Institutes of Health.

Conflicts of interest
Brunsing RL reports a grant from GE. Fowler KJ reports grant support from GE and Bayer; personal
consultation fees from 12 Sigma, Innovis, and Bayer. Yokoo T reports no conflict of interest. Cunha GM
reports no conflict of interest. Sirlin CB reports grants from GE, Siemens, Philips, Bayer, Foundation of
NIH, Gilead; personal consultation fees from Blade, Boehringer, and Epigenomics; consultation under
the auspices of the University to AMRA, BMS, Exact Sciences, GE Digital, and IBM-Watson; lab service
agreements from Enanta, Gilead, ICON, Intercept, Nusirt, Shire, Synageva, Takeda; royalties from Wolters
Kluwer for educational material outside the submitted work. Marks RM reports no conflicts of interest. The
views expressed in this article are those of the authors and do not necessarily reflect the official policy or
position of the Department of the Navy, Department of Defense, or the U.S. Government.

Ethical approval and consent to participate
Not applicable.

Consent for publication
Not applicable.