Horigome H, Nomura T, Saso K, Joh T, Ohara H, Akita S, Sobue S, Mizuno Y, Kato Y, Kanematsu T, Murasaki G, Itoh M
First Department of Internal Medicine, Nagoya City University Medical School, 1-Kawasumi, Mizuho-cho, Mizuho-ku, Nagoya City, Japan 467-8601.
Hepatogastroenterology. 2000 Nov-Dec;47(36):1659-62.
BACKGROUND/AIMS: To compare the effectiveness of different imaging modalities and the significance of tumor biopsy for diagnosing small hepatocellular carcinoma.
Nodules (n = 352) with diameters of 30 mm or less newly detected by periodic ultrasonography and computed tomography in 234 patients with chronic liver disease were investigated with magnetic resonance imaging and digital subtraction angiography. These findings were compared with histologic findings. Histologic diagnoses were dysplastic nodule (n = 23), well-differentiated hepatocellular carcinoma (n = 163), moderately differentiated hepatocellular carcinoma (n = 159), and poorly differentiated hepatocellular carcinoma (n = 7). We compared three groups based on-diameters of 10, 11-20, and 21-30 mm. Nodules were diagnosed as hepatocellular carcinoma if they had hypervascular staining on digital subtraction angiography, hyperintensity on magnetic resonance T2-weighted images, arterial phase enhancement on enhanced magnetic resonance imaging, or low-high-low density on enhanced computed tomography.
Imaging alone was sufficient to diagnose hepatocellular carcinoma in 66.3% of the well-differentiated nodules and 91.6% of the moderately and poorly differentiated nodules (P < 0.001) The size of the nodule influenced the diagnosis of hepatocellular carcinoma by imaging alone in 65.5% (< or = 10 mm), 77.2% (11-20 mm), and 92.3% (21-30 mm) (< or = 10 vs. 21-30: P < 0.0001, 11-20 vs. 21-30: P < 0.0005). It was impossible to determine the degree of differentiation of the hepatocellular carcinoma by imaging alone.
The effectiveness of imaging for the diagnosis of hepatocellular carcinoma improved with decreasing differentiation and increasing diameter of the nodules. Tumor biopsy was required to make a histological accurate diagnosis.
背景/目的：比较不同成像方式对小肝细胞癌的诊断效果以及肿瘤活检的意义。
对234例慢性肝病患者定期进行超声和计算机断层扫描新发现的直径30mm及以下的结节（n = 352）进行磁共振成像和数字减影血管造影检查。将这些结果与组织学结果进行比较。组织学诊断为发育异常结节（n = 23）、高分化肝细胞癌（n = 163）、中分化肝细胞癌（n = 159）和低分化肝细胞癌（n = 7）。根据直径将结节分为三组：10mm、11 - 20mm和21 - 30mm。若结节在数字减影血管造影上有血管丰富染色、磁共振T2加权图像上呈高信号、增强磁共振成像上有动脉期强化或增强计算机断层扫描上呈低-高-低密度，则诊断为肝细胞癌。
仅通过成像即可诊断高分化结节中的66.3%以及中分化和低分化结节中的91.6%的肝细胞癌（P < 0.001）。结节大小对仅通过成像诊断肝细胞癌有影响，直径≤10mm的结节中为65.5%，11 - 20mm的结节中为77.2%，21 - 30mm的结节中为92.3%（≤10mm与21 - 30mm比较：P < 0.0001，11 - 20mm与21 - 30mm比较：P < 0.0005）。仅通过成像无法确定肝细胞癌的分化程度。
成像对肝细胞癌的诊断效果随着结节分化程度降低和直径增大而提高。需要进行肿瘤活检以做出准确的组织学诊断。
