Division of Diagnostic Imaging and Intervention, Department of Liver Transplantation, Hepatology and Infectious Diseases, University of Pisa, Pisa, Italy.
Dig Liver Dis. 2010 Jul;42 Suppl 3:S223-7. doi: 10.1016/S1590-8658(10)60509-9.
Patients at high risk for developing hepatocellular carcinoma (HCC) should be enrolled in surveillance programs based on ultrasound (US) examinations performed at 6-month intervals. Nodules found during US surveillance that are smaller than 1 cm should be followed-up with US at 3-month intervals. If the nodule found during US surveillance is larger than 1 cm, it should be investigated further with contrast-enhanced dynamic radiological studies, including US, multidetector computed tomography, or magnetic resonance imaging. If the appearance is typical for HCC (i.e., the lesion shows hypervascularization in the arterial phase with washout in the portal venous or the equilibrium phase), biopsy is considered unnecessary and the lesion can be treated as HCC. For nodules between 1 and 2 cm, it is currently recommended that such non-invasive diagnosis be based on the evidence of coincidental features typical for HCC from at least two dynamic imaging techniques. If the vascular profile on imaging is not characteristic or the nodule is detected in a non-cirrhotic liver, biopsy should be performed. If the biopsy is negative for HCC, patients should be followed-up by imaging studies performed at 3-month intervals until the nodule either disappears, enlarges, or displays diagnostic characteristics of HCC.
对于有发生肝细胞癌（HCC）风险的患者，应根据每 6 个月进行的超声（US）检查，将其纳入监测计划中。在 US 监测期间发现的直径小于 1cm 的结节应每 3 个月进行 US 随访。如果在 US 监测期间发现的结节大于 1cm，则应进一步进行增强动态放射学研究，包括 US、多排 CT 或 MRI。如果表现为 HCC 的典型特征（即病变在动脉期呈高血供，门静脉期或平衡期呈洗脱），则认为不需要进行活检，可以将病变视为 HCC 进行治疗。对于直径在 1 至 2cm 之间的结节，目前建议这种非侵入性诊断应基于至少两种动态成像技术的 HCC 特征的偶然特征的证据。如果影像学上的血管特征不典型，或者在非肝硬化肝脏中检测到结节，则应进行活检。如果活检未检出 HCC，则应通过每 3 个月进行的影像学研究进行随访，直到结节消失、增大或显示出 HCC 的诊断特征。
