84% and sensitivity to be 91% with a large meta-analysis of cohort studies (4). However, the accuracy of US can be affected by the difficulty of finding a tumor in a nodular liver and limited by operator dependence, obesity and body habitus. Although surveillance with contrast enhanced imaging may be more accurate than US, these modalities are constrained by the need for intravenous contrast and the cost. The authors do mention that an abbreviated MRI may be more cost effective and studies are underway to explore this. There are also ongoing studies that aim to enhance patient compliance with HCC surveillance. These may involve electronic medical record reminders to physicians and better systems to call back patients for testing.