Early detection of hepatocellular carcinoma by Hyperpolarized [1- 13C]pyruvate MRI

Prior treatment

• Pacemaker, neurostimulator or cholera implant

Other illness

• Chronic kidney disease
• Competing systemic disease (hypertension, dyslipidemia, diabetes etc. allowed)
• Allergy to pyruvate
• Significant cardiac disease (as left ventricular outflow obstruction or heart failure)
• Significant obstructive lung disease or severe asthma
• Unsafe medical implants (safety of heart valves, hips and the like must be confirmed)

Lab values

• Patients with tumors must have eGFR > 30 ml/min/1.73m2

Other

• Contraindications for MRI with contrast:
• Hepatic encephalopathy ≥ grade 2.
• Stents or other devices implanted close to the liver that may cause imaging artefacts
• Metal foreign bodies such as fragments and irremovable piercings
• Largest circumference including arms > 160 cm
• Claustrophobia

• Aged 18 – 85 years. The age and gender of the healthy controls of the main study will be matched to the participating patients.
• Pre-menopausal women must be confirmed non-pregnant by an onsite test
• HCC group: - Diagnosed HCC larger than 10 mm confirmed by standard MRI, CT or confirmed by tumour biopsy. - Subgroup 1: Not elected for liver surgery - Subgroup 2: Elected for liver surgery
• Small tumor group: - One or more small lesions in the liver requiring 2 years of repeated follow-up as per the EASL guideline. Could be in a liver with a confirmed HCC.