The Impact of Vascular and Nonvascular Findings on the Noninvasive Diagnosis of Small Hepatocellular Carcinoma Based on the EASL and AASLD Criteria
- 1 March 2010
- journal article
- research article
- Published by Ovid Technologies (Wolters Kluwer Health) in American Journal Of Gastroenterology
- Vol. 105 (3), 599-609
- https://doi.org/10.1038/ajg.2009.654
Abstract
Noninvasive criteria for the diagnosis of hepatocellular carcinoma (HCC) in cirrhosis, recommended by the European Association for the Study of Liver (EASL) in 2001 and by the American Association for the Study of Liver Diseases (AASLD) in 2005, have left a number of small liver neoplastic nodules undefined. We designed this prospective study in 2003 with the aims of assessing the diagnostic contribution of vascular contrast-enhanced techniques and investigating the possible additional contribution of superparamagnetic iron oxide magnetic resonance (SPIO-MR) in this setting. Between 2003 and 2005, 75 consecutive small (10–30 mm) liver nodules detected at ultrasonography in 60 patients with cirrhosis were prospectively submitted to contrast-enhanced ultrasound (CEUS), helical-computed tomography (helical-CT), and gadolinium magnetic resonance (gad-MR), each blinded to the other. A total of 68 nodules were also studied with SPIO-MR at the same time as gad-MR. Using the EASL noninvasive criteria, the diagnosis of HCC was established in 44 of 55 (80%) nodules with a final diagnosis of HCC. Gad-MR was the most sensitive technique for detecting the typical vascular pattern. SPIO-MR showed a pattern consistent with HCC in 5 of 10 HCCs, not satisfying the EASL noninvasive criteria, and was negative in 17 of 18 (94.4%) nonmalignant nodules. The review of the present case series according to the AASLD criteria for the noninvasive diagnosis of HCC yielded a sensitivity rate of 81.8%. This study shows that both EASL and AASLD noninvasive recall strategies for nodules of 10–30 mm in the cirrhotic liver, based on the vascular pattern of nodules, have a false-negative rate of ∼ 20%. SPIO-MR may increase the diagnostic potential of noninvasive techniques, contributing to the diagnosis of HCC lacking a typical vascular pattern.Keywords
This publication has 21 references indexed in Scilit:
- Recent advances in the diagnosis of hepatocellular carcinomaHepatology Research, 2007
- Management of hepatocellular carcinomaHepatology, 2005
- Characterization of small nodules in cirrhosis by assessment of vascularity: The problem of hypovascular hepatocellular carcinomaHepatology, 2005
- Characterization of Focal Liver Lesions with Contrast-specific US Modes and a Sulfur Hexafluoride–filled Microbubble Contrast Agent: Diagnostic Performance and ConfidenceRadiology, 2004
- Evaluation of hepatocellular carcinoma using SonoVue, a second generation ultrasound contrast agent: correlation with cellular differentiationEuropean Radiology, 2004
- MRI angiography is superior to helical CT for detection of HCC prior to liver transplantation: An explant correlationHepatology, 2003
- Clinical Management of Hepatocellular Carcinoma. Conclusions of the Barcelona-2000 EASL ConferenceJournal of Hepatology, 2001
- Fast 3D dynamic MR imaging of the liver with MR SmartPrep: Comparison with helical CT in detecting hypervascular hepatocellular carcinomaClinical Imaging, 2001
- Hepatocellular Carcinoma in the Cirrhotic Liver: Double-Contrast MR Imaging for DiagnosisRadiology, 2000
- Terminology of nodular hepatocellular lesionsHepatology, 1995