Paisant Anita, Boursier Jérôme, Dabli Djamel, Lebigot Jérôme, Oberti Frédéric, Michalak Sophie, Vilgrain Valérie, Aubé Christophe
Département de Radiologie, Centre Hospitalier Universitaire d'Angers, 49933 Angers, France.
Laboratoire HIFIH, EA 3859, Université d'Angers, 49045 Angers, France.
J Clin Med. 2022 Jul 22;11(15):4282. doi: 10.3390/jcm11154282.
Screening programmes for cirrhotic patients are based on ultrasound (US) examinations at 6-month intervals, but a US sensitivity of 47% has recently been reported. The aim of this study was to evaluate a two-phase MDCT protocol in terms of hepatic nodule detection within a hepatocellular carcinoma (HCC) screening situation and to evaluate a reduction in irradiation dose for the 6-monthly checks compared to the classic four-phase protocol. In total, 373 patients with 498 nodules that were suspected to be HCC and ranged from 10 to 30 mm in size were prospectively included. All patients underwent four-phase MDCT with an unenhanced phase, arterial phase (AP), portal phase (PP) and delayed phase (DP). The cumulative irradiation from the repeated 6-monthly MDCT protocol was calculated. Of the 498 nodules, only 4 (0.008%) were only seen in the PP and not in the AP or AP. Of the 319 HCC nodules, 270 (84.6%) had AP hyperenhancement, while 115 had washout in the PP and 224 had washout in the DP. Overall, 222 of the 224 (99.1%) HCC nodules with typical features were seen in the AP and DP. The dose reduction was estimated at 55.4% when using the two-phase protocol (AP and DP). The cumulative irradiation of the two-phase protocol, which was performed every 6 months over 5 years, was 96.5 mSv. MDCT with the two-phase protocol could offer an alternative to ultrasound screening with an interesting risk-benefit trade-off.
肝硬化患者的筛查方案基于每6个月进行一次超声（US）检查，但最近有报道称超声的敏感性为47%。本研究的目的是评估一种两期MDCT方案在肝细胞癌（HCC）筛查情况下对肝结节的检测能力，并评估与经典四期方案相比，6个月一次检查时辐射剂量的减少情况。总共前瞻性纳入了373例患者，其498个结节疑似为HCC，大小在10至30毫米之间。所有患者均接受了包括平扫期、动脉期（AP）、门静脉期（PP）和延迟期（DP）的四期MDCT检查。计算了重复的6个月一次MDCT方案的累积辐射量。在498个结节中，只有4个（0.008%）仅在门静脉期被发现，而在动脉期或延迟期未被发现。在319个HCC结节中，270个（84.6%）有动脉期强化，115个在门静脉期有廓清，224个在延迟期有廓清。总体而言，224个具有典型特征的HCC结节中有222个（99.1%）在动脉期和延迟期被发现。使用两期方案（动脉期和延迟期）时，估计剂量减少了55.4%。在5年期间每6个月进行一次的两期方案的累积辐射量为96.5 mSv。采用两期方案的MDCT可以为超声筛查提供一种替代方案，具有有趣的风险效益权衡。
