Powell-Jackson P, Forbes A, Michell M, Williams R
Liver Unit, King's College Hospital, London.
Br J Radiol. 1987 Dec;60(720):1221-2. doi: 10.1259/0007-1285-60-720-1221.
The effect of cirrhosis on the accuracy of ultrasonography and scintigraphy in the diagnosis of hepatocellular carcinoma (HCC) has not been established. We have therefore studied the findings on ultrasound and scintigraphy in four groups of patients. Fourteen had HCC and cirrhosis, 13 had HCC but no cirrhosis, 53 had cirrhosis but no HCC and 31 had evidence neither of cirrhotic nor malignant liver disease. The accuracies of a positive interpretation of HCC on ultrasound and scintigraphy in the absence of cirrhosis were 85% and 66% respectively (NS), but fell (significantly in the case of scintigraphy: p less than 0.05) to 80% and 31% respectively in the presence of cirrhosis (p less than 0.01). The poorer performance of scintigraphy in the presence of cirrhosis was a result both of its lower sensitivity (50% compared with 85%) and the greater frequency of false positives (28% vs 5%: p less than 0.001). The accuracy of a negative interpretation of HCC on scintigraphy in the absence of cirrhosis was 96% but fell to 84% in the presence of cirrhosis, whereas on ultrasound it remained the same (96%). In conclusion, we recommend ultrasound in preference to scintigraphy as a more accurate technique for the diagnosis of HCC in the presence of cirrhosis.
肝硬化对超声检查和闪烁扫描法诊断肝细胞癌（HCC）准确性的影响尚未明确。因此，我们研究了四组患者的超声和闪烁扫描检查结果。14例患者患有HCC和肝硬化，13例患有HCC但无肝硬化，53例有肝硬化但无HCC，31例既无肝硬化也无肝脏恶性疾病迹象。在无肝硬化的情况下，超声和闪烁扫描法对HCC阳性诊断的准确率分别为85%和66%（无显著差异），但在有肝硬化的情况下，分别降至80%和31%（闪烁扫描法有显著差异：p<0.05）（p<0.01）。闪烁扫描法在有肝硬化时表现较差，这是由于其较低的敏感性（50%，而超声为85%）以及较高的假阳性率（28%对5%：p<0.001）。在无肝硬化的情况下，闪烁扫描法对HCC阴性诊断的准确率为96%，但在有肝硬化时降至84%，而超声的阴性诊断准确率保持不变（96%）。总之，我们推荐在诊断有肝硬化的HCC时，超声比闪烁扫描法更准确，应优先选择超声检查。
