Department of Digestive Diseases and Internal Medicine, University of Bologna, Bologna, Italy.
Am J Gastroenterol. 2010 Mar;105(3):599-609. doi: 10.1038/ajg.2009.654. Epub 2009 Nov 24.
Noninvasive criteria for the diagnosis of hepatocellular carcinoma (HCC) in cirrhosis, recommended by the European Association for the Study of Liver (EASL) in 2001 and by the American Association for the Study of Liver Diseases (AASLD) in 2005, have left a number of small liver neoplastic nodules undefined. We designed this prospective study in 2003 with the aims of assessing the diagnostic contribution of vascular contrast-enhanced techniques and investigating the possible additional contribution of superparamagnetic iron oxide magnetic resonance (SPIO-MR) in this setting.
Between 2003 and 2005, 75 consecutive small (10-30 mm) liver nodules detected at ultrasonography in 60 patients with cirrhosis were prospectively submitted to contrast-enhanced ultrasound (CEUS), helical-computed tomography (helical-CT), and gadolinium magnetic resonance (gad-MR), each blinded to the other. A total of 68 nodules were also studied with SPIO-MR at the same time as gad-MR.
Using the EASL noninvasive criteria, the diagnosis of HCC was established in 44 of 55 (80%) nodules with a final diagnosis of HCC. Gad-MR was the most sensitive technique for detecting the typical vascular pattern. SPIO-MR showed a pattern consistent with HCC in 5 of 10 HCCs, not satisfying the EASL noninvasive criteria, and was negative in 17 of 18 (94.4%) nonmalignant nodules. The review of the present case series according to the AASLD criteria for the noninvasive diagnosis of HCC yielded a sensitivity rate of 81.8%.
This study shows that both EASL and AASLD noninvasive recall strategies for nodules of 10-30 mm in the cirrhotic liver, based on the vascular pattern of nodules, have a false-negative rate of approximately 20%. SPIO-MR may increase the diagnostic potential of noninvasive techniques, contributing to the diagnosis of HCC lacking a typical vascular pattern.
2001 年，欧洲肝脏研究学会（EASL）和 2005 年美国肝脏研究学会（AASLD）推荐了用于诊断肝硬化患者肝细胞癌（HCC）的非侵入性标准，但仍有一些小的肝肿瘤结节无法明确诊断。因此，我们于 2003 年进行了这项前瞻性研究，旨在评估血管对比增强技术的诊断贡献，并研究在此背景下超顺磁氧化铁磁共振（SPIO-MR）可能的额外贡献。
2003 年至 2005 年，在 60 例肝硬化患者的超声检查中发现了 75 个连续的小（10-30mm）肝结节，前瞻性地接受了超声造影（CEUS）、螺旋 CT（螺旋 CT）和钆磁共振（gad-MR）检查，每种检查均与其他检查相独立。同时，对 68 个结节也进行了 SPIO-MR 研究。
根据 EASL 的非侵入性标准，在最终诊断为 HCC 的 55 个结节中，有 44 个（80%）诊断为 HCC。gad-MR 是检测典型血管模式最敏感的技术。SPIO-MR 在 10 个 HCC 中的 5 个显示符合 HCC 的模式，不符合 EASL 的非侵入性标准，在 18 个（94.4%）非恶性结节中均为阴性。根据 AASLD 非侵入性 HCC 诊断标准回顾本病例系列，其敏感性为 81.8%。
本研究表明，基于结节的血管模式，EASL 和 AASLD 用于诊断肝硬化患者 10-30mm 结节的非侵入性回顾策略，其假阴性率约为 20%。SPIO-MR 可能会提高非侵入性技术的诊断潜能，有助于诊断缺乏典型血管模式的 HCC。
