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The DeLIVER team will evaluate non-contrast-enhanced MRI and compare it to standard of care ultrasound in a cohort of patients under surveillance for liver cancer.

Researchers from the Universities of Oxford, Nottingham, Bournemouth and Glasgow Caledonian will lead the £2.2 million AMULET clinical study into the use of a new imaging technique for surveillance of liver cancer in patients with cirrhosis. Led by Dr Michael Pavlides (study chief investigator, Radcliffe Department of Medicine, University of Oxford),  Professor Susan Francis (study lead technical investigator, University of Nottingham) and Associate Professor Jamie Franklin (study lead radiologist, Bournemouth University), the study is funded by the Efficacy and Mechanism Evaluation (EME) Programme, a partnership between the National Institute for Health and Care Research and the Medical Research Council. The team will compare non-contrast-enhanced magnetic resonance imaging (MRI) to the standard of care ultrasound to assess which imaging technique is better for diagnosing liver cancer earlier.

Liver cancer incidence is increasing and by 2038-2040 there could be around 9,700 new diagnoses of liver cancer every year (Cancer Research UK). Most cases of liver cancer arise in people with liver cirrhosis. Therefore, people with cirrhosis undergo regular surveillance by ultrasound with the aim of detecting liver cancer earlier. The earlier that liver cancer is detected, the more likely that treatment will be successful. However, liver ultrasound has poor sensitivity in some patients meaning that early liver cancers can be missed.

MRI is not routinely used for liver cancer surveillance. A normal clinical liver MRI scan uses an injected dye (contrast), but this technique may not be ideal for surveillance because it is more invasive for patients, adds time and cost, and the dye can accumulate in the brain with repeated doses. The study team are developing a shorter non-contrast-enhanced MRI protocol, as an alternative to ultrasound and contrast-enhanced MRI, with the aim of using it for more sensitive surveillance.

This new funding from the EME programme for AMULET will allow the evaluation of non-contrast-enhanced MRI in a prospective cohort of 300 patients with liver cirrhosis recruited as part of the DeLIVER programme (funded by Cancer Research UK). In addition to determining the feasibility and diagnostic accuracy of this new technology compared to ultrasound, this study may shed light on the biology of transformation from liver cirrhosis to liver cancer that may inform future early detection and prevention strategies.