Radiology considerations for the PREMIUM study: a multicenter randomized controlled trial of abbreviated MRI versus ultrasound for liver cancer screening in cirrhosis

This paper describes the rationale and radiology considerations in the implementation of the Preventing Liver Cancer Mortality through Imaging with Ultrasound versus MRI (PREMIUM) study. PREMIUM is a multicenter, randomized controlled trial sponsored by the Department of Veterans Affairs comparing dynamic contrast-enhanced (DCE) abbreviated MRI (aMRI) plus serum AFP versus ultrasound (US) plus serum AFP for hepatocellular carcinoma (HCC) screening in patients with cirrhosis. PREMIUM aims to randomize 4,700 participants across over 47 Veterans Affairs Medical Centers to semiannual surveillance for up to eight years, with HCC-related mortality as the primary endpoint. To date, 35 sites have been activated with 1,085 patients randomized. To ensure uniform implementation and reporting of per-protocol screening, the PREMIUM Radiology Workgroup developed standardized imaging protocols, structured LI-RADS-based reporting templates, and a centralized training program for radiologists and technologists. They also perform ongoing quality control on both scans and reports. The aMRI protocols utilize multiphasic post-contrast imaging to allow LI-RADS scoring. A non-contrast-enhanced aMRI protocol is available for participants who develop renal impairment or contrast allergy during the study. US protocols conform to US LI-RADS standards. Structured reporting promotes consistency in documentation of findings, visualization scores, and follow-up recommendations. A centralized Image Repository was established, incorporating advanced de-identification methods to remove metadata and pixel-embedded protected health information from imaging files. More than 20,000 curated liver MRI and US exams are anticipated, supporting both trial outcomes and future radiomics and artificial intelligence research. PREMIUM aims to determine whether screening for HCC with a DCE aMRI protocol reduces HCC-related mortality and also facilitates ancillary studies utilizing the Image Repository.

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Publication Details

Journal
Abdominal Radiology
Published
2026-09-06
DOI
https://doi.org/10.1007/s00261-026-05720-w
Primary Topic
Hepatocellular Carcinoma Treatment and Prognosis
Type
article
Field-Weighted Citation Impact
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article

Radiology considerations for the PREMIUM study: a multicenter randomized controlled trial of abbreviated MRI versus ultrasound for liver cancer screening in cirrhosis

Grant D. Huang, Linda M. McDonald, Jihane N. Benhammou, Luis E. Selva et al.
Abdominal Radiology
Hepatocellular Carcinoma Treatment and Prognosis
article

Radiology considerations for the PREMIUM study: a multicenter randomized controlled trial of abbreviated MRI versus ultrasound for liver cancer screening in cirrhosis

Grant D. Huang, Linda M. McDonald, Jihane N. Benhammou, Luis E. Selva, Stephanie T. Chang, Amit G. Singal, Michael V. Beheshti, Rajni Mehta, Dell P. Dunn, George N. Ioannou, Grace L. Su, Tassos C. Kyriakides, Genta Dani, Ifeyinwa Onyiuke, Beata Planeta, Shari S. Rogal, Lynn Buchwalder, Ashu Sharma, Cynthia A. Moylan, Alexey Kotlik, R. Boland, Rafael B. Fricks, Mustafa R. Bashir, Tamar H. Taddei, Timothy R. Morgan, David E. Kaplan, The Premium Study Group, Nhan V. Do, Ghassan K. Abou-Alfa, Jason A. Dominitz, Noel S. Weiss
article en

Abstract

This paper describes the rationale and radiology considerations in the implementation of the Preventing Liver Cancer Mortality through Imaging with Ultrasound versus MRI (PREMIUM) study. PREMIUM is a multicenter, randomized controlled trial sponsored by the Department of Veterans Affairs comparing dynamic contrast-enhanced (DCE) abbreviated MRI (aMRI) plus serum AFP versus ultrasound (US) plus serum AFP for hepatocellular carcinoma (HCC) screening in patients with cirrhosis. PREMIUM aims to randomize 4,700 participants across over 47 Veterans Affairs Medical Centers to semiannual surveillance for up to eight years, with HCC-related mortality as the primary endpoint. To date, 35 sites have been activated with 1,085 patients randomized. To ensure uniform implementation and reporting of per-protocol screening, the PREMIUM Radiology Workgroup developed standardized imaging protocols, structured LI-RADS-based reporting templates, and a centralized training program for radiologists and technologists. They also perform ongoing quality control on both scans and reports. The aMRI protocols utilize multiphasic post-contrast imaging to allow LI-RADS scoring. A non-contrast-enhanced aMRI protocol is available for participants who develop renal impairment or contrast allergy during the study. US protocols conform to US LI-RADS standards. Structured reporting promotes consistency in documentation of findings, visualization scores, and follow-up recommendations. A centralized Image Repository was established, incorporating advanced de-identification methods to remove metadata and pixel-embedded protected health information from imaging files. More than 20,000 curated liver MRI and US exams are anticipated, supporting both trial outcomes and future radiomics and artificial intelligence research. PREMIUM aims to determine whether screening for HCC with a DCE aMRI protocol reduces HCC-related mortality and also facilitates ancillary studies utilizing the Image Repository.

Abdominal Radiology
Boston University (US), Creighton University (US), United States Department of Veterans Affairs (US), Memorial Sloan Kettering Cancer Center (US), Medical University of South Carolina (US), University of California, Los Angeles (US), University of Pittsburgh (US), Duke University (US), University of Washington (US), VA Palo Alto Health Care System (US), Cornell University (US), University of Utah (US), University of Michigan (US), VA Boston Healthcare System (US), VA Office of Research and Development (US), Yale University (US), VA Connecticut Healthcare System (US), VA Puget Sound Health Care System (US), University of California, Irvine Medical Center (US), Central Arkansas Veterans Healthcare System (US), VA Ann Arbor Healthcare System (US), Ralph H. Johnson VA Medical Center (US), Philadelphia VA Medical Center (US), VA Pittsburgh Healthcare System (US), Durham VA Medical Center (US), Ann Arbor Center for Independent Living (US), Department of Veterans Affairs (AU), Carl T. Hayden Veterans Affairs Medical Center (US), VA Long Beach Healthcare System (US), VA Greater Los Angeles Healthcare System (US), George E. Wahlen Department of VA Medical Center (US), Seattle University (US), University of Pennsylvania (US), The University of Texas Southwestern Medical Center (US), Stanford University (US)
Good health and well-being
Openalex Percentile: Top 12%
Hepatocellular Carcinoma Treatment and Prognosis
DOIOpen Access PDFOpenAlex
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