Bennett Genevieve L, Krinsky Glenn A, Abitbol Roxanne J, Kim Sue Y, Theise Neil D, Teperman Lewis W
Department of Abdominal Radiology, New York University Medical Center, 560 First Avenue, New York, NY 10016, USA.
AJR Am J Roentgenol. 2002 Jul;179(1):75-80. doi: 10.2214/ajr.179.1.1790075.
The objective of this study was to determine the sensitivity and specificity of sonography as an aid in detecting hepatocellular carcinomas and dysplastic nodules using explantation correlation in patients with cirrhosis and no known hepatocellular carcinomas.
The sonography reports of 200 patients with cirrhosis who underwent sonography and then underwent liver transplantation within 90 days were retrospectively reviewed for focal solid liver lesions. All focal solid masses detected on sonography were considered possible hepatocellular carcinomas. The sonographic findings were compared with thin-section explanted liver pathologic results.
Twenty-seven patients (13.5%) had hepatocellular carcinoma at explantation, including four patients with diffuse, multifocal tumors. Eight of the 39 lesions were detected on sonography for a patient sensitivity of 29.6% and a lesion sensitivity of 20.5%. Sonography revealed three (75%) of four hepatocellular carcinomas larger than 5 cm in diameter, one (50%) of two hepatocellular carcinomas with diameters of 3.1-5.0 cm, one (20%) of five hepatocellular carcinomas with diameters of 2.1-3.0 cm, three (13.6%) of 22 hepatocellular carcinomas with diameters of 1-2 cm, and no lesions with diameters smaller than 1 cm. Forty-two patients (21%) had a total of 126 dysplastic nodules including two patients with innumerable lesions. Sonography depicted only two dysplastic nodules, for a patient sensitivity of 4.8% and a lesion sensitivity of 1.6%. The overall specificity of sonography for either hepatocellular carcinomas or dysplastic nodules was 96%.
Sonography has low sensitivity but high specificity in revealing hepatocellular carcinomas and dysplastic nodules in patients with a cirrhotic liver requiring liver transplantation. In these patients, sonography should not be the sole imaging modality used for lesion detection before transplantation.
本研究的目的是通过对肝硬化且无已知肝细胞癌患者进行肝移植相关性分析，确定超声检查在检测肝细胞癌和发育异常结节方面的敏感性和特异性。
回顾性分析200例肝硬化患者的超声检查报告，这些患者在90天内接受了超声检查，随后接受了肝移植，以查找肝脏局灶性实性病变。超声检查发现的所有局灶性实性肿块均被视为可能的肝细胞癌。将超声检查结果与肝移植后的肝脏病理切片结果进行比较。
27例（13.5%）患者在肝移植时患有肝细胞癌，其中4例为弥漫性、多灶性肿瘤。在超声检查中检测出39个病变中的8个，患者敏感性为29.6%，病变敏感性为20.5%。超声检查发现直径大于5 cm的4例肝细胞癌中的3例（75%），直径为3.1 - 5.0 cm的2例肝细胞癌中的1例（50%），直径为2.1 - 3.0 cm的5例肝细胞癌中的1例（20%），直径为1 - 2 cm的22例肝细胞癌中的3例（13.6%），直径小于1 cm的病变未被检测出。42例（21%）患者共有126个发育异常结节，其中2例有无数个病变。超声检查仅发现2个发育异常结节，患者敏感性为4.8%，病变敏感性为1.6%。超声检查对肝细胞癌或发育异常结节的总体特异性为96%。
超声检查在发现需要肝移植的肝硬化患者的肝细胞癌和发育异常结节方面敏感性较低，但特异性较高。对于这些患者，超声检查不应作为移植前病变检测的唯一影像学检查方法。
