Sutherland Tom, Watts Jane, Ryan Marno, Galvin Angela, Temple Faye, Vuong Jason, Little Andrew Francis
Medical Imaging Department, St Vincents Hospital, Fitzroy, Victoria, Australia.
Gastroenterology Department, St Vincents Hospital, Fitzroy, Victoria, Australia.
J Med Imaging Radiat Oncol. 2017 Feb;61(1):34-39. doi: 10.1111/1754-9485.12513. Epub 2016 Aug 25.
Ultrasound is a widely utilized method of screening patients with chronic liver disease for hepatocellular carcinoma (HCC). However, the sensitivity of ultrasound for small tumours is limited. We have prospectively compared ultrasound screening with diffusion-weighted (DWI) MRI for detecting HCC.
Patients with chronic liver disease referred for ultrasound screening underwent a liver ultrasound and a liver MRI comprising free breathing DWI. Each test was independently read to determine the accuracy of each modality for detecting HCC.
One hundred and ninety-two patients were recruited and HCC was diagnosed in six patients (3%); all of whom were detected at ultrasound screening, and five detected at MRI screening. Ultrasound had false-positive studies 20 times (10%) while DWI MRI had three false-positive examinations (2%) p≥0.05. The sensitivity, specificity, positive predictive value and negative predictive values for ultrasound are 100%, 90%, 23% and 100%, respectively, while for MRI are 83%, 98%, 63% and 99%.
In patients with chronic liver disease undergoing surveillance for hepatocellular carcinoma, DWI MRI screening shows similar sensitivity to screening ultrasound but with a significantly lower false-positive rate.
超声是一种广泛用于筛查慢性肝病患者肝细胞癌（HCC）的方法。然而，超声对小肿瘤的敏感性有限。我们前瞻性地比较了超声筛查与扩散加权（DWI）MRI检测HCC的效果。
因超声筛查而转诊的慢性肝病患者接受了肝脏超声检查和包含自由呼吸DWI的肝脏MRI检查。每项检查由独立人员解读，以确定每种检查方式检测HCC的准确性。
共招募了192名患者，其中6名（3%）被诊断为HCC；所有患者均在超声筛查中被检测出，5名在MRI筛查中被检测出。超声有20次假阳性检查（10%），而DWI MRI有3次假阳性检查（2%），p≥0.05。超声的敏感性、特异性、阳性预测值和阴性预测值分别为100%、90%、23%和100%，而MRI的相应值分别为83%、98%、63%和99%。
在接受肝细胞癌监测的慢性肝病患者中，DWI MRI筛查显示出与筛查超声相似的敏感性，但假阳性率显著更低。
