AMULET: Abbreviated Magnetic Resonance Imaging vs ultrasound surveillance for liver cancer detection in people at high risk of developing liver cancer
- Genomics and economics
Alcohol excess, fatty liver, and hepatitis B or C can lead to liver cirrhosis. It is estimated that a third of people with cirrhosis will develop liver cancer in their lifetime. If liver cancer is diagnosed early, it can be cured. Ultrasound scans can raise suspicion for liver cancer and are usually done every six months (surveillance) in people with cirrhosis to help with early diagnosis. However, ultrasound can miss early cancers even in people having scans every six months. Furthermore, the risk of cancer is higher in people with more advanced cirrhosis and in people with cirrhosis from hepatitis B or C, and it is possible that they need better tests than ultrasound. Computed tomography (CT) and magnetic resonance imaging (MRI) scans with dye injection (contrast) are used for liver cancer diagnosis. However, they cannot be done every six months because of costs, capacity, and toxicity from high CT radiation doses, and MRI contrast accumulation in the brain with repeated contrast injections. MRI scans without contrast are not toxic, can be done in 20 minutes, and are cheaper, so can be done every six months.
MRI without contrast may raise suspicion of liver cancer in cases missed by ultrasound, so it could be used for surveillance instead of ultrasound. In this study, we want to find out if it is beneficial to use a quick MRI without contrast as surveillance for liver cancer in people with cirrhosis in the NHS, and to compare this MRI with ultrasound. AMULET is a prospective, multicentre study in 300 participants with cirrhosis at high risk of developing HCC. Study participants will have an ultrasound scan every six months, like all people with cirrhosis, and an additional six‑monthly non‑contrast MRI scan for three years (six visits). All participants will have an MRI with contrast at the end of three years to ensure that no cancers were missed.
The health economic evaluation for AMULET is examining the cost‑effectiveness of the use of non‑contrast‑enhanced MRI and ultrasound scans as surveillance tools for HCC diagnosis in the NHS. The main outcome measure is health‑related quality of life, measured using the EQ‑5D.
Funder: National Institute for Health Research