Accuracy and disagreement of computed tomography and magnetic resonance imaging for the diagnosis of small hepatocellular carcinoma and dysplastic nodules: Role of biopsy
Accuracy and disagreement of computed tomography and magnetic resonance imaging for the diagnosis of small hepatocellular carcinoma and dysplastic nodules: Role of biopsy
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DOI：
10.1002/hep.24746
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发表时间：
2012-03-01
期刊：
影响因子：
13.5
通讯作者：
Degos, Francoise
中科院分区：
文献类型：
--
作者：
Serste, Thomas;Barrau, Vincent;Degos, Francoise
肝脏大结节，从良性到低度或高度异型增生结节（LGDN/HGDN）和肝细胞癌（HCC），可能在慢性肝病（CLD）期间发生。目前的指南是最近更新的，小肝癌的无创诊断标准是基于单一的典型放射学模式和两种技术的非决定性巧合结果。本研究旨在评估无创多相检查诊断肝癌和异型增生结节（DN）的准确性和分歧以及活检的作用。74例连续CLD患者超声检测到1-2 cm结节，在1个月内接受了多相计算机断层扫描（CT）、磁共振成像（MRI）和结节活检。中位年龄为60岁; 33例患者（45%）患有丙型肝炎病毒，20例（27%）患有B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LGDNs，1例胆管癌和1例上皮样血管内皮瘤。其余18例均无肿瘤发生。所有患者（31/31; 100%）具有结论性巧合结果（即，动脉增强和洗脱）有HCC或HGDN（敏感性，57%;特异性，100%）。所有患者（51/51; 100%）在两次检查中至少有一次有结论性结果，有HCC或HGDN（敏感性，96%;特异性，100%）。74例患者中有21例（28%）的CT和MRI影像学结果不一致，74例患者中有23例（31%）的两种检查均未洗脱。在这44例患者中，肝活检提供了初步准确的诊断。结论：如果在一次动态影像检查中发现肝动脉强化和洗脱，则可无创性诊断HCC或HGDN。这些结果在CT和MRI上经常不一致，支持活检在小肝癌诊断中的地位。（肝脏病学2011）
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. Conclusion: 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. (HEPATOLOGY 2011)