Assistance-Publique Hôpitaux de Paris, APHP Service d'Hépatologie, Hôpital Beaujon, Clichy, France.
Hepatology. 2012 Mar;55(3):800-6. doi: 10.1002/hep.24746. Epub 2012 Jan 30.
Liver macronodules, ranging from benign to low-grade or high-grade dysplastic nodules (LGDNs/HGDNs) and hepatocellular carcinoma (HCC), may develop during chronic liver diseases (CLDs). Current guidelines were recently updated and the noninvasive criteria for the diagnosis of small HCC are based on a single typical radiological pattern and nonconclusive coincidental findings with two techniques. This study aimed to assess the accuracy and disagreements of noninvasive multiphasic examinations for the diagnosis of HCC and dysplastic nodules (DNs) and the role of biopsy. Seventy-four consecutive patients with CLD with ultrasound-detected 1-2-cm nodules underwent, within 1 month, multiphasic computed tomography (CT), magnetic resonance imaging (MRI), and biopsy of the nodule. Median age was 60 years; 33 patients (45%) had hepatitis C virus, 20 (27%) had hepatitis B virus, and 13 (18%) patients had no cirrhosis. Biopsy revealed 47 HCCs, 6 HGDNs, 1 LGDNs, 1 cholangiocarcinoma, and 1 epithelioid hemangioendothelioma. There were no tumors in the other 18 patients. All patients (31 of 31; 100%) who had conclusive coincidental findings (i.e., arterial enhancement and washout) on both examinations had HCC or HGDN (sensitivity, 57%; specificity, 100%). All patients (51 of 51; 100%) who had conclusive findings on at least one of the two examinations had HCC or HGDN (sensitivity, 96%; specificity, 100%). There was a disagreement regarding imaging findings between CT and MRI in 21 of 74 (28%) patients and no washout on both examinations in 23 of 74 patients (31%). In these 44 patients, liver biopsy provided an initial accurate diagnosis.
The noninvasive diagnosis of HCC or HGDN can be obtained if arterial enhancement and washout are found in a single dynamic imaging examination. These findings are frequently discordant on both CT and MRI, supporting the place of biopsy for the diagnosis of small HCCs.
评估多相无创检查对 HCC 和异型增生结节（DNs）诊断的准确性和分歧，以及活检的作用。
74 例经超声检测到 1-2cm 结节的慢性肝病（CLD）连续患者在 1 个月内接受多相 CT、MRI 和结节活检。中位年龄为 60 岁；33 例（45%）患者有丙型肝炎病毒，20 例（27%）患者有乙型肝炎病毒，13 例（18%）患者无肝硬化。活检显示 47 例 HCC、6 例 HGDN、1 例 LGDN、1 例胆管癌和 1 例上皮样血管内皮细胞瘤。其余 18 例患者无肿瘤。在两项检查均有明确偶发发现（即动脉增强和廓清）的 31 例患者（100%）中均有 HCC 或 HGDN（敏感性 57%，特异性 100%）。在至少一项检查中有明确发现的 51 例患者（100%）中均有 HCC 或 HGDN（敏感性 96%，特异性 100%）。在 74 例患者中，CT 和 MRI 之间的影像学结果存在 21 例（28%）分歧，74 例患者中均无廓清现象的有 23 例（31%）。在这 44 例患者中，肝活检提供了最初的准确诊断。
如果在单次动态影像学检查中发现动脉增强和廓清，则可以获得 HCC 或 HGDN 的无创诊断。这些发现在 CT 和 MRI 上经常不一致，支持活检用于诊断小 HCC。
