Department of Gastroenterology, Kobe Asahi Hospital, 3-5-25 Bououji-cho, Nagata-ku, Kobe 653-0801, Japan.
World J Gastroenterol. 2010 Sep 7;16(33):4187-92. doi: 10.3748/wjg.v16.i33.4187.
To compare the imaging results with histology and to evaluate the diagnostic sensitivity of imaging modalities for hepatocellular carcinoma (HCC) smaller than 2 cm.
Nodules smaller than 2 cm (n = 34) revealed by ultrasonography (US) in 29 patients with liver cirrhosis were analyzed. Histological diagnosis of HCC was performed by ultrasonographic guidance: moderately-differentiated HCC (n = 24); well-differentiated HCC (n = 10). The patterns disclosed by the four imaging modalities defined the conclusive diagnosis of HCC: (1) contrast-enhanced computed tomography (CECT), hypervascularity in the arterial phase and washout in the equilibrium phase; (2) Sonazoid contrast-enhanced US (CEUS), hypervascularity in the early vascular phase and defect in the Kupffer phase; (3) gadolinium-ethoxybenzyl-diethylenetriamine pentaacetic acid (Gd-EOB-DTPA)-enhanced magnetic resonance imaging (MRI), hypervascularity in the arterial phase and/or defect in the hepatobiliary phase; and (4) CT arterioportal angiography: hypervascularity by CT during arteriography and/or perfusion defect by CT during arterial portography.
Overall, the sensitivity of diagnosing HCC smaller than 2 cm was 52.9% (18/34) (95% CI: 35.1-70.2) by CECT; 67.6% (23/34) (95% CI: 49.5-82.6) by Sonazoid CEUS; 76.5% (26/34) (95% CI: 58.8-89.3) by Gd-EOB-DTPA MRI; and 88.2% (30/34) (95% CI: 72.5-96.7) by CT arterioportal angiography. The diagnostic sensitivity of detecting moderately-differentiated HCC by CECT, Sonazoid CEUS, Gd-EOB-DTPA MRI and CT arterioportal angiography was 62.5% (15/24) (95% CI: 40.6-81.2), 79.2% (19/24) (95% CI: 57.8-92.9), 75.0% (18/24) (95% CI: 53.3-90.2) and 95.8% (23/24) (95% CI: 78.9-99.9), respectively. A significant difference (P < 0.05) was observed between CECT and CT arterioportal angiography in all nodules. There was no difference between Sonazoid CEUS, Gd-EOB-DTPA MRI, and CT arterioportal angiography. The combined sensitivity of Sonazoid CEUS and Gd-EOB-DTPA MRI was 94.1% (32/34).
Changing the main diagnostic modality for HCC smaller than 2 cm from CT arterioportal angiography to Sonazoid CEUS and Gd-EOB-DTPA MRI is recommended.
比较影像学结果与组织学结果，评估小于 2cm 的肝细胞癌（HCC）的影像学检查方法的诊断灵敏度。
对 29 例肝硬化患者的超声检查发现的小于 2cm 的结节（n=34）进行分析。通过超声引导进行 HCC 的组织学诊断：中分化 HCC（n=24）；高分化 HCC（n=10）。四种影像学模式揭示的模式明确了 HCC 的诊断：（1）对比增强计算机断层扫描（CECT），动脉期高血管性和平衡期洗脱；（2） SonoVue 超声造影（CEUS），早期血管期高血管性和库普弗期缺损；（3）钆乙氧基苯甲基二乙三胺五乙酸（Gd-EOB-DTPA）增强磁共振成像（MRI），动脉期高血管性和/或肝胆期缺损；（4）CT 动脉门静脉造影：动脉造影期间 CT 的高血管性和/或动脉门静脉造影期间 CT 的灌注缺损。
总体而言，CECT 诊断小于 2cm HCC 的灵敏度为 52.9%（18/34）（95%CI：35.1-70.2）；SonoVue CEUS 为 67.6%（23/34）（95%CI：49.5-82.6）；Gd-EOB-DTPA MRI 为 76.5%（26/34）（95%CI：58.8-89.3）；CT 动脉门静脉造影为 88.2%（30/34）（95%CI：72.5-96.7）。CECT、SonoVue CEUS、Gd-EOB-DTPA MRI 和 CT 动脉门静脉造影对中分化 HCC 的诊断灵敏度分别为 62.5%（15/24）（95%CI：40.6-81.2）、79.2%（19/24）（95%CI：57.8-92.9）、75.0%（18/24）（95%CI：53.3-90.2）和 95.8%（23/24）（95%CI：78.9-99.9）。在所有结节中，CECT 与 CT 动脉门静脉造影之间存在显著差异（P<0.05）。SonoVue CEUS、Gd-EOB-DTPA MRI 和 CT 动脉门静脉造影之间无差异。SonoVue CEUS 和 Gd-EOB-DTPA MRI 的联合灵敏度为 94.1%（32/34）。
建议将小于 2cm HCC 的主要诊断方式从 CT 动脉门静脉造影改为 SonoVue CEUS 和 Gd-EOB-DTPA MRI。
