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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\u2013based 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.<\/jats:p>","DOI":"10.1007\/s00261-026-05720-w","type":"journal-article","created":{"date-parts":[[2026,9,6]],"date-time":"2026-09-06T09:45:23Z","timestamp":1788687923000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Radiology considerations for the PREMIUM study: a multicenter randomized controlled trial of abbreviated MRI versus ultrasound for liver cancer screening in cirrhosis"],"prefix":"10.1007","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-8418-5676","authenticated-orcid":false,"given":"Dell 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The views expressed in this article are those of the authors and do not necessarily reflect the position or policy of the Department of Veterans Affairs or the US government.Dell P. Dunn: No conflicts of interest Genta Dani: No conflicts of interest Ashu Sharma: No conflicts of interest George N. Ioannou: No conflicts of interest Tamar H. Taddei: No conflicts of interest Stephanie T. Chang: No conflicts of interest Ifeyinwa Y. Onyiuke: No conflicts of interest Beata M. Planeta: No conflicts of interest Grant D. Huang: No conflicts of interest Noel S. Weiss: No conflicts of interest Timothy R. Morgan: No conflicts of interest Jason A. Dominitz: No conflicts of interest Ghassan K. Abou-Alfa: Conflicts of interest Research support from Abbvie, Agenus, Arcus, Astra Zeneca, Atara, Beigene, BioNtech, BMS, Coherus, Digestive Care, Elicio, Genentech\/Roche, Helsinn, J-Pharma, Parker Institute, Pertyze, Yiviva, and consulting support from Abbvie, Ability Pharma, Agenus, Alligator Biosciences, Astellas, Arcus, Astra Zeneca, Autem, Berry Genomics, BioNtech, BMS, Boehringer Ingelheim, Fibrogen, Genentech\/Roche, Ipsen, J-Pharma, Merck, Merus, Moma Therapeutics, Neogene, Novartis, Regeneron, Revolution Medicines, Servier, Syros, Tango, Tempus, Vector, Yiviva Mustafa R. Bashir: Conflicts of interest (specifically relevant to this study): Grant to institution as PI: Bayer Healthcare; Conflicts of interest (general, not specifically relevant to this study): Consulting: United Therapeutics, Rectify Pharma, ICON, Grants to institution as PI: Siemens Healthineers, Madrigal Pharmaceuticals, Corcept Therapeutics, NGM Biopharmaceuticals Michael V. Beheshti: No conflicts of interest Amit G. Singal: Conflicts of interest Served as consultant or on advisory boards for Genentech, AstraZeneca, Eisai, Exelixis, Bayer, Merck, Elevar, Boston Scientific, Sirtex, FujiFilm Medical Sciences, Exact Sciences, Helio Genomics, Roche, ImCare, Curve Biosciences, Universal Dx, Glycotest, Mursla, DELFI, and Abbott Cynthia (A) Moylan: Conflicts of interest research grants to institution: Madrigal, GSK, Exact Sciences: consulting: NovoNordisk, Sirtex Robin J. Boland: No conflicts of interest Lynn F. Buchwalder: No conflicts of interest Rajni L. Mehta: No conflicts of interest Kimberly S. Hoisington: No conflicts of interest Luis E. Selva: No conflicts of interest Rafael (B) Fricks: No conflicts of interest Alexey Kotlik: No conflicts of interest Nhan V. Do: No conflicts of interest Shari S. Rogal: Conflicts of interest: Grants to institution from VA ORD, PCORI, and CDC David E. Kaplan: Conflict of Interest Research funding to institution from AstraZeneca, Bausch, Bluejay Therapeutics, Exact Sciences, Gilead. Jihane M. Benhamou: No conflicts of interest Grace L. Su: No conflicts of interest Linda M. McDonald: No conflicts of interest Tassos (C) Kyriakides: No conflicts of interest.","order":1,"name":"Ethics","label":"Competing interests","group":{"name":"EthicsHeading","label":"Declarations"}}]}}