Hepatocellular carcinoma in cirrhotic patients: prospective comparison of US, CT and MR imaging
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Hepatocellular carcinoma in cirrhotic patients: prospective comparison of US, CT and MR imaging Michele Di Martino & Gianmaria De Filippis & Adriano De Santis & Daniel Geiger & Maurizio Del Monte & Concetta Valentina Lombardo & Massimo Rossi & Stefano Ginanni Corradini & Gianluca Mennini & Carlo Catalano Received: 25 April 2012 / Revised: 13 September 2012 / Accepted: 20 September 2012 / Published online: 18 November 2012 # European Society of Radiology 2012
Abstract Objectives To 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. Methods One 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 (2 cm). Results Significantly higher diagnostic accuracy, sensitivity and NPV was achieved on dynamic + hepatobiliary phase M. Di Martino : G. De Filippis : D. Geiger : M. Del Monte : C. V. Lombardo : C. Catalano (*) Department of Radiological Sciences, Oncology and Anatomical Pathology, University of Rome “Sapienza”, Viale Regina Elena 324, Rome 00161, Italy e-mail: [email protected] A. De Santis : S. G. Corradini Department of Clinical Medicine, Division of Gastroenterology, University of Rome “Sapienza”, Viale Regina Elena 324, Rome 00161, Italy M. Rossi : G. Mennini Department of General Surgery, Division of Organ Transplantation, University of Rome “Sapienza”, Viale Regina Elena 324, Rome 00161, Italy
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. Conclusions Dynamic + 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 Keywords Hepatocellular carcinoma . Ultrasound . Multidetector computed tomography . Magnetic resonance imaging . Liver specific contrast agent
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