Skip to main content
Key Specialties
Cardiology Diabetology Endocrinology Gastroenterology Geriatrics and Gerontology Gynecology and Obstetrics Hematology Infectious Disease Internal Medicine Nephrology Neurology Oncology Pediatrics Respiratory Medicine Rheumatology Surgery
Congress Coverage
2024 ACC Congress 2023 ESMO Congress 2023 EASD Congress 2023 ERS Congress 2023 ESC Congress
Clinical Collections
Advances in Alzheimer’s

At a glance: The STEP trials

A round-up of the STEP phase 3 clinical trials evaluating semaglutide for weight loss in people with overweight or obesity.
ADVANCED SEARCH
Log in
Top
European Radiology
Published in: European Radiology 4/2013

01-04-2013 | Gastrointestinal

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

Authors: 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

Published in: European Radiology | Issue 4/2013

Login to get access

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 (<1 cm, 1-2 cm, >2 cm).

Results

Significantly 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.

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
Literature
1.
Yang JD, Roberts LR (2010) Epidemiology and management of hepatocellular carcinoma. Infect Dis Clin North Am 24:899–919PubMedCrossRef
2.
Gomaa AI, Khan SA, Toledano MB, Waked I, Taylor-Robinson SD (2008) Hepatocellular carcinoma: epidemiology, risk factors and pathogenesis. World J Gastroenterol 14:4300–4308PubMedCrossRef
3.
Gambarin-Gelwan M, David CD, Shapiro R et al (2000) Sensitivity of commonly available screening test in detecting hepatocellular carcinoma in cirrhotic patients undergoing liver transplantation. Am J Gastroenterol 95:1535–1538PubMedCrossRef
4.
Reinhold C, Hammers L, Taylor CR et al (1995) Characterization of focal hepatic lesions with Duplex sonogrphy: findings in 198 patients. AJR Am J Roentgenol 164:1131–1135PubMedCrossRef
5.
Noguchi Y, Murakami T, Kim T et al (2003) Detection of hepatocellular carcinoma: comparison of dynamic MR imaging with dynamic double arterial phase helical CT. AJR Am J Roentgenol 180:455–460PubMedCrossRef
6.
Kim YK, Kim CS, Chung GH et al (2006) Comparison of gadobenate dimeglumine-enhanced MR and 16-MDCT for the detection of hepatocellular carcinoma. AJR Am J Roentgenol 186:149–157PubMedCrossRef
7.
Peterson MS, Baron RL, Marsh JW, Oliver JH III, Confer SR, Hunt LE (2000) Pretransplantation Surveillance for possible hepatocellular carcinoma in patients with cirrhosis: epidemiology and CT-based tumor detection rate in 430 cases with surgical pathologic correlation. Radiology 217:743–749PubMed
8.
Sangiovanni A, Manini MA, Iavarone M et al (2010) The diagnostic and economic impact of contrast imaging techniques in the diagnosis of small hepatocellular carcinoma in cirrhosis. Gut 59:638–644PubMedCrossRef
9.
Teefey SA, Hildeboldt CC, Dehdashti F et al (2003) Detection of primary hepatic malignancy in liver transplant candidates: prospective comparison of CT, MR imaging, US, PET. Radiology 226:533–542PubMedCrossRef
10.
Libbrecht L, Bielen D, Verslype C et al (2002) Focal lesions in cirrhotic explant livers: pathological evaluation and accuracy of pretransplantation imaging examinations. Liver Transpl 8:749–761PubMedCrossRef
11.
Freeman RB, Mithoefer A, Ruthazer R et al (2006) Optimizing staging for hepatocellular carcinoma before liver transplantation: a retrospective analysis of the UNOS/OPTN database. Liver Transpl 12:1504–1511PubMedCrossRef
12.
Boone JM (2006) Multidetector CT: opportunities, challenges, and concerns associated with scanners with 64 or more detector rows. Radiology 241:334–337PubMedCrossRef
13.
Marin D, Catalano C, De Filippis G et al (2009) Detection of hepatocellular carcinoma in patients with cirrosi: added value of coronal multiplanar reformations from isotropix voxel with 64-MDCT. AJR Am J Roentgenol 192:775–782CrossRef
14.
D’Onofrio M, Faccioli N, Zamboni G et al (2008) Focal liver lesions in cirrohosis: value of contrast-enhanced ultrasonography compared with Doppler ultrasound and alpha-fetoprotein levels. Radiol Med 113:978–991
15.
Baron RL, Oliver JH III, Confer S et al (1997) Screening cirrhosis for hepatocellular carcinoma (HCC) with helical contrast CT: specificity. Radiology 2005:143
16.
Bruix J, Scherman M, Llovet JM et al (2001) Clinical managment of hepatocellular carcinoma. Conclusions of the barcellona-2000 EASL conference. Europe Assosation for the Study of the Liver. J Hepatol 35:421–430PubMedCrossRef
17.
Marin D, Di Martino M, Guerrisi A et al (2009) Hepatocellular carcinoma in patients with cirrhosis: qualitative comparison of gadobenate dimeglumine-enhanced MR imaging and multiphasic 64-section CT. Radiology 251:1–8CrossRef
18.
Kim JI, Lee MJ, Choi JY et al (2008) The value of gadobenate dimeglumine-enhanced delayed phase MR imaging for characterization of hepatocellular carcinoma nodules in the cirrhotic liver. Invest Radiol 43:202–210PubMedCrossRef
19.
Kim YK, Kim SC, Lee YH et al (2004) Comaprison of superparamgnetic Iron Oxide-Enhanced and gadobenate dimeglumine-enhanced MRI for detection of small hepatocellular carcinomas. AJR Am J Roentgenol 182:1217–1223PubMedCrossRef
20.
Hammerstingl R, Huppertz A, Breuer J et al (2008) Diagnostic efficacy of gadoxedic acid (Primovist)-enhanced MRI and spiral CT for a therapeutic strategy: comparison with intraopeartive and histological findings in focal lilver lesions. Eur Radiol 18:457–467PubMedCrossRef
21.
Di Martino M, Marin D, Guerrisi G et al (2010) Intraindividual comparison of gadoxetate disodium-enhanced MR imaging and 64-section multidetector CT in the detection of hepatocellular carcinoma in patients with cirrhosis. Radiology 256:806–816PubMedCrossRef
22.
Ebara M, Hatano R, Fukuda H et al (1998) Natural course of small hepatocellular carcinoma with underlying cirrhosis. A study of 30 patients. Hepatogastroenterology 45:1214–1220PubMed
23.
International Working Party (1995) Terminology of nodular hepatocellular lesions. Hepatology 22:983–993
24.
25.
26.
Forner A, Vilana R, Ayuso C et al (2008) Diagnosis of hepatic nodules 20 mm or smaller in cirrhosis: prospective validation of non invasive diagnostic criteria for hepatocellular carcinoma. Hepatology 47:97–104PubMedCrossRef
27.
Chakraborty DP (2006) Analysis of location specific observer performance data: validated extensions of the jackknife free-response (JAFROC) method. Acad Radiol 13:1187–1193PubMedCrossRef
28.
Schwnke C, Busse R (2007) Analysis of differences in proportions from clustered data with multiple measurements in disgnostic studies. Methods Inf Med 46:548–552
29.
Bruix J, Scherman M (2011) Management of hepatocellular carcinoma: an update. Hepatology 53:1020–1022PubMedCrossRef
30.
Vogl TJ, Stupavsky A, Pegios W et al (1997) Hepatocellular carcinoma: evaluation of dynamic and static gadobenate dimeglumine-enhanced MR imaging and histopatologic correlation. Radiology 205:721–728PubMed
31.
Grazioli L, Morana G, Caudana R et al (2000) Hepatocellular Carcinoma: Correlation between gadobenate dimeglumine-enhanced MRI and pathologic findings. Invest Radiol 35:25–34PubMedCrossRef
32.
Morana G, Grazioli L, Kirchin MA et al (2011) Solid hypervascular liver lesions: accurate identification of true benign lesions on enhanced dynamic and hepatobiliary phase magnetic resonance imaging after gadobenate dimeglumine administration. Invest Radiol 46:225–239PubMedCrossRef
33.
Choi B, Kim T, Han J et al (2000) Vascularity of hepatocellular carcinoma: assessment with contrast-enhanced scond harmonic versus color Doppler ultrasound. Radiology 214:167–172
34.
Strobel D, Kleinecke C, Hänsler J et al (2005) Contrast-enhanced sonography for the characterisation of hepatocellular carcinomas—correlation with histological differentiation. Ultraschall Med 26:270–276PubMedCrossRef
35.
Dănilă M, Sporea I, Sirli R, Popescu A, Sendroiu M, Martie A (2010) The role of contrast enhanced ultrasound (CEUS) in the assessment of liver nodules in patients with cirrhosis. Med Ultrason 12:145–149PubMed
36.
Xu PJ, Yan FH, Wang JH, Shan Y, Ji Y, Chen CZ (2010) Contribution of diffusion-weighted magnetic resonance imaging in the characterization of hepatocellular carcinomas and dysplastic nodules in cirrhotic liver. J Comput Assist Tomogr 34:506–512PubMedCrossRef
37.
Bartolozzi C, Battaglia V, Bozzi E (2011) Hepatocellular nodules in liver cirrhosis: contrast enhanced MR. Abdom Imaging 36:290–299PubMedCrossRef
Metadata
Title
Hepatocellular carcinoma in cirrhotic patients: prospective comparison of US, CT and MR imaging
Authors
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
Publication date
01-04-2013
Publisher
Springer-Verlag
Published in
European Radiology / Issue 4/2013
Print ISSN: 0938-7994
Electronic ISSN: 1432-1084
DOI
https://doi.org/10.1007/s00330-012-2691-z

Other articles of this Issue 4/2013

European Radiology 4/2013 Go to the issue

Urogenital

Peritoneal inclusion cysts: clinical characteristics and imaging features

Gastrointestinal

Unit costs in population-based colorectal cancer screening using CT colonography performed in university hospitals in The Netherlands

Interventional

Added value of FDG-PET imaging in the diagnostic workup for yttrium-90 radioembolisation in patients with colorectal cancer liver metastases

Neuro

Susceptibility-weighted angiography for the detection of high-flow intracranial vascular lesions: preliminary study

Neuro

Brain atrophy associations with white matter lesions in the ageing brain: the Lothian Birth Cohort 1936

Computed Tomography

Optimal threshold in CT quantification of emphysema