C.R.C. "A.M. & A. Migliavacca Center for Liver Disease" and Division of Gastroenterology and Hepatology, University of Milan and Fondazione IRCCS Ca' Granda Maggiore Hospital, Milan, Italy.
Hepatology Unit, Ospedale San Giuseppe, Università di Milano, Milan, Italy.
Ann Hepatol. 2019 Mar-Apr;18(2):318-324. doi: 10.1016/j.aohep.2018.09.002. Epub 2019 Apr 17.
The American Association for the Study of the Liver (AASLD) recommends contrast computerized tomography (CT-scan) and magnetic resonance (MRI) to diagnose hepatocellular carcinoma (HCC) arising in cirrhotic patients under semiannual surveillance with abdominal ultrasound (US). A US guided fine needle biopsy (FNB) serves the same purpose in radiologically undiagnosed tumors and incidentally detected nodules in cirrhotics outside surveillance. In this population, we evaluated the performance of radiological diagnosis of HCC according to 2010 AASLD recommendations.
All cirrhotic patients with a liver nodule incidentally detected by US were prospectively investigated with a sequential application of CT-scan/MRI examination and a FNB.
Between 2011 and 2015, 94 patients (mean age 67 years) had a liver nodule (total 120) detected by US in the context of histologically confirmed cirrhosis. Mean nodules diameter was 40 (10-160) mm, 87 (73%) <5cm. At histology, 84 (70%) nodules were HCC, 8 (7%) intrahepatic cholangiocarcinoma, 6 (5%) metastases, 2 (2%) neuroendocrine tumors and 20 (16%) benign lesions. Hyperenhancement in arterial phase followed by wash-out in venous phases on at least one radiological technique was demonstrated in 62 nodules (61 HCC, 1 high grade dysplastic nodule), with a specificity of 97% (IC95%: 85-100%), sensitivity 73% (IC95%: 62-81%) and diagnostic accuracy 80%, being 64% for ≥5cm HCC. Sensitivity of AFP >200ng/mL was 12% (IC95%: 6-23%).
A single contrast imaging technique showing a typical contrast pattern confidently identifies HCC also in cirrhotic patients with an incidental liver nodule, thereby reducing the need for FNB examinations.
美国肝病研究学会（AASLD）建议在半年度腹部超声监测下，对肝硬化患者进行对比计算机断层扫描（CT 扫描）和磁共振成像（MRI）以诊断肝细胞癌（HCC）。对于影像学未诊断的肿瘤和监测之外的肝硬化患者偶然发现的结节，超声引导下细针活检（FNB）也可达到相同的目的。在该人群中，我们根据 2010 年 AASLD 建议评估 HCC 的放射学诊断表现。
所有因超声偶然发现肝结节的肝硬化患者均前瞻性地接受 CT 扫描/MRI 检查和 FNB 检查。
2011 年至 2015 年，94 例（平均年龄 67 岁）患者因组织学证实的肝硬化接受超声检查，发现肝脏结节 120 个。平均结节直径为 40（10-160）mm，87 个（73%）<5cm。组织学上，84 个（70%）结节为 HCC，8 个（7%）为肝内胆管细胞癌，6 个（5%）为转移灶，2 个（2%）为神经内分泌肿瘤，20 个（16%）为良性病变。至少一种影像学技术显示动脉期强化后静脉期洗脱的 62 个结节（61 个 HCC，1 个高级别异型增生结节），特异性为 97%（95%CI：85-100%），敏感性为 73%（95%CI：62-81%），诊断准确性为 80%，对于≥5cm HCC 为 64%。AFP>200ng/mL 的敏感性为 12%（95%CI：6-23%）。
在肝硬化患者中，单次对比成像技术显示典型对比模式可明确诊断 HCC，从而减少 FNB 检查的需要。
