Hepatocellular carcinoma in cirrhotic patients: prospective comparison of US, CT and MR imaging

AbstractObjectivesTo prospectively compare the diagnostic performance of ultrasound (US), multidetector computed tomography (MDCT) and contrast-enhanced magnetic resonance imaging (MRI) in cirrhotic patients who were candidates for liver transplantation.MethodsOne hundred and forty consecutive patients with 163 hepatocellular carcinoma (HCC) nodules underwent US, MRI and MDCT. Diagnosis of HCC was based on pathological findings or substantial growth at 12-month follow-up. Four different image datasets were evaluated: US, MDCT, MRI unenhanced and dynamic phases, MRI unenhanced dynamic and hepatobiliary phase. Diagnostic accuracy, sensitivity, specificity, PPV and NPV, with corresponding 95 % confidence intervals, were determined. Statistical analysis was performed for all lesions and for three lesion subgroups (<1 cm, 1-2 cm, >2 cm).ResultsSignificantly higher diagnostic accuracy, sensitivity and NPV was achieved on dynamic + hepatobiliary phase MRI compared with US, MDCT and dynamic phase MRI alone. The specificity and PPV of US was significantly lower than that of MDCT, dynamic phase MRI and dynamic + hepatobiliary phase MRI. Similar results were obtained for all sub-group analyses, with particular benefit for the diagnosis of smaller lesions between 1 and 2 cm.ConclusionsDynamic + hepatobiliary phase MRI improved detection and characterisation of HCC in cirrhotic patients. The greatest benefit is for diagnosing lesions between 1 and 2 cm.Key Points• US, CT and MRI can all identify HCC in cirrhotic patients • US has good sensitivity but suffers from false-positive findings • Dynamic CT and MR have similar diagnostic performance for diagnosing HCC • Dynamic + hepatobiliary phase MRI significantly improves detection and characterisation of HCC • The greatest benefit is for the diagnosis of lesions between 1 and 2 cm

[1]  M. Schwartz,et al.  Sensitivity of commonly available screening tests in detecting hepatocellular carcinoma in cirrhotic patients undergoing liver transplantation , 2000, American Journal of Gastroenterology.

[2]  I. Sporea,et al.  The role of contrast enhanced ultrasound (CEUS) in the assessment of liver nodules in patients with cirrhosis. , 2010, Medical ultrasonography.

[3]  E. Hahn,et al.  Contrast-enhanced sonography for the characterisation of hepatocellular carcinomas--correlation with histological differentiation. , 2005, Ultraschall in der Medizin.

[4]  John M Boone,et al.  Multidetector CT: opportunities, challenges, and concerns associated with scanners with 64 or more detector rows. , 2006, Radiology.

[5]  Michael Laniado,et al.  Diagnostic efficacy of gadoxetic acid (Primovist)-enhanced MRI and spiral CT for a therapeutic strategy: comparison with intraoperative and histopathologic findings in focal liver lesions , 2008, European Radiology.

[6]  H. Fukuda,et al.  Natural course of small hepatocellular carcinoma with underlying cirrhosis. A study of 30 patients. , 1998, Hepato-gastroenterology.

[7]  S. Solomon,et al.  Can local radiofrequency ablation of tumors generate systemic immunity against metastatic disease? , 2009, Radiology.

[8]  Young Kon Kim,et al.  Comparison of superparamagnetic iron oxide-enhanced and gadobenate dimeglumine-enhanced dynamic MRI for detection of small hepatocellular carcinomas. , 2004, AJR. American journal of roentgenology.

[9]  V. Runge,et al.  Contrast enhanced MRI. Evaluation of a canine model of osmotic blood-brain barrier disruption. , 1985, Investigative radiology.

[10]  C. Catalano,et al.  Intraindividual comparison of gadoxetate disodium-enhanced MR imaging and 64-section multidetector CT in the Detection of hepatocellular carcinoma in patients with cirrhosis. , 2010, Radiology.

[11]  C. Bartolozzi,et al.  Hepatocellular nodules in liver cirrhosis: contrast-enhanced MR , 2011, Abdominal Imaging.

[12]  A. Jacob,et al.  Pedal angiography in peripheral arterial occlusive disease: first-pass i.v. contrast-enhanced MR angiography with blood pool contrast medium versus intraarterial digital subtraction angiography. , 2009, AJR. American journal of roentgenology.

[13]  L Pagliaro,et al.  Clinical management of hepatocellular carcinoma. Conclusions of the Barcelona-2000 EASL conference. European Association for the Study of the Liver. , 2001, Journal of hepatology.

[14]  J. Heiken,et al.  Detection of primary hepatic malignancy in liver transplant candidates: prospective comparison of CT, MR imaging, US, and PET. , 2003, Radiology.

[15]  J. Bruix,et al.  Management of hepatocellular carcinoma , 2005, Hepatology.

[16]  C. Harvey,et al.  Ultrasound of focal liver lesions , 2001, European Radiology.

[17]  Young Kon Kim,et al.  Comparison of gadobenate dimeglumine-enhanced dynamic MRI and 16-MDCT for the detection of hepatocellular carcinoma. , 2006, AJR. American journal of roentgenology.

[18]  B. Choi,et al.  Vascularity of hepatocellular carcinoma: assessment with contrast-enhanced second-harmonic versus conventional power Doppler US. , 2000, Radiology.

[19]  T. Roskams,et al.  Focal lesions in cirrhotic explant livers: Pathological evaluation and accuracy of pretransplantation imaging examinations , 2002, Liver transplantation : official publication of the American Association for the Study of Liver Diseases and the International Liver Transplantation Society.

[20]  Ann Harper,et al.  Optimizing staging for hepatocellular carcinoma before liver transplantation: A retrospective analysis of the UNOS/OPTN database , 2006, Liver transplantation : official publication of the American Association for the Study of Liver Diseases and the International Liver Transplantation Society.

[21]  Carlo Catalano,et al.  Hepatocellular carcinoma in patients with cirrhosis: qualitative comparison of gadobenate dimeglumine-enhanced MR imaging and multiphasic 64-section CT. , 2009, Radiology.

[22]  C. Reinhold,et al.  Characterization of focal hepatic lesions with duplex sonography: findings in 198 patients. , 1995, AJR. American journal of roentgenology.

[23]  J. Bruix,et al.  Diagnosis of hepatic nodules 20 mm or smaller in cirrhosis: Prospective validation of the noninvasive diagnostic criteria for hepatocellular carcinoma , 2007, Hepatology.

[24]  Jae Young Lee,et al.  The Value of Gadobenate Dimeglumine-Enhanced Delayed Phase MR Imaging for Characterization of Hepatocellular Nodules in the Cirrhotic Liver , 2008, Investigative radiology.

[25]  N. Faccioli,et al.  Solid Hypervascular Liver Lesions: Accurate Identification of True Benign Lesions on Enhanced Dynamic and Hepatobiliary Phase Magnetic Resonance Imaging After Gadobenate Dimeglumine Administration , 2011, Investigative radiology.

[26]  C. Aubéa,et al.  Diagnosis of hepatocellular carcinoma , 2014 .

[27]  Carlo Catalano,et al.  Detection of hepatocellular carcinoma in patients with cirrhosis: added value of coronal reformations from isotropic voxels with 64-MDCT. , 2009, AJR. American journal of roentgenology.

[28]  G. Morana,et al.  Hepatocellular carcinoma: correlation between gadobenate dimeglumine-enhanced MRI and pathologic findings. , 2000, Investigative radiology.

[29]  Dev P Chakraborty,et al.  Analysis of location specific observer performance data: validated extensions of the jackknife free-response (JAFROC) method. , 2006, Academic radiology.

[30]  Yuan Ji,et al.  Contribution of Diffusion-Weighted Magnetic Resonance Imaging in the Characterization of Hepatocellular Carcinomas and Dysplastic Nodules in Cirrhotic Liver , 2010, Journal of computer assisted tomography.

[31]  Massimo Midiri,et al.  Focal liver lesions: contrast-enhanced ultrasound , 2009, Abdominal Imaging.

[32]  S. Taylor-Robinson,et al.  Hepatocellular carcinoma: epidemiology, risk factors and pathogenesis. , 2008, World journal of gastroenterology.

[33]  W. Middleton,et al.  Follow-up of patients at low risk for hepatic malignancy with a characteristic hemangioma at US. , 2000, Radiology.

[34]  C Schwenke,et al.  Analysis of Differences in Proportions from Clustered Data with Multiple Measurements in Diagnostic Studies , 2007, Methods of Information in Medicine.

[35]  S. Kumano,et al.  Detection of hepatocellular carcinoma: comparison of dynamic MR imaging with dynamic double arterial phase helical CT. , 2003, AJR. American journal of roentgenology.

[36]  W. Pegios,et al.  Hepatocellular carcinoma: evaluation with dynamic and static gadobenate dimeglumine-enhanced MR imaging and histopathologic correlation. , 1997, Radiology.

[37]  L. Roberts,et al.  Epidemiology and management of hepatocellular carcinoma. , 2010, Infectious disease clinics of North America.

[38]  I. Wanless,et al.  Terminology of nodular hepatocellular lesions , 1995 .

[39]  L. Forzenigo,et al.  The diagnostic and economic impact of contrast imaging techniques in the diagnosis of small hepatocellular carcinoma in cirrhosis , 2009, Gut.

[40]  J W Marsh,et al.  Pretransplantation surveillance for possible hepatocellular carcinoma in patients with cirrhosis: epidemiology and CT-based tumor detection rate in 430 cases with surgical pathologic correlation. , 2000, Radiology.

[41]  J. Bruix,et al.  Management of hepatocellular carcinoma: An update , 2011, Hepatology.