Alpha fetoprotein, ultrasound, computerized tomography and magnetic resonance imaging for detection of hepatocellular carcinoma in patients with advanced cirrhosis
Alpha fetoprotein, ultrasound, computerized tomography and magnetic resonance imaging for detection of hepatocellular carcinoma in patients with advanced cirrhosis
复制标题
DOI：
10.1111/j.1365-2036.2007.03498.x
复制
发表时间：
2007-11-01
影响因子：
7.6
通讯作者：
Davis, G. L.
中科院分区：
文献类型：
--
作者：
Snowberger, N.;Chinnakotla, S.;Davis, G. L.
背景血清甲胎蛋白（AFP）、超声、计算机断层扫描和磁共振成像常用于筛查肝硬化患者的肝细胞癌（HCC）。目的评估晚期肝硬化筛查的准确性。方法研究组由239例在肝移植时已证实在移植肝脏中确诊为HCC的患者组成。在转诊时进行 AFP 和影像学检查，并连续进行直至移植。结果 78% 在肝移植前检测出肝细胞癌，22% 是偶然发现的。肝硬化的病因是丙型肝炎 (HCV) (55%)、乙型肝炎 (HBV) (17%)、酒精 (9%) 和其他/未知 (19%)。尽管 AFP 升高了 62%，但中位水平为 15 ng/mL。只有 26%、15% 和 13% 分别超过 100、400 和 1000 ng/mL。相比之下，在没有 HCC 的情况下，AFP 升高了 20%，但只有 3% 的人超过 100 ng/mL。无论截止值如何，AFP 的总体准确性都很差。磁共振成像在检测肿瘤方面比计算机断层扫描或超声波更准确，特别是在移植后 3 个月内进行时。结论 磁共振成像对 HCC 成像最敏感，并且最能反映实际肿瘤大小。 AFP 不敏感，对筛查策略几乎没有什么帮助，但在极度升高时具有预后价值。
BackgroundSerum alpha fetoprotein (AFP), ultrasound, computerized tomography scanning, and magnetic resonance imaging are commonly used to screen for hepatocellular carcinoma (HCC) in patients with cirrhosis.AimTo assess the accuracy of screening in advanced cirrhosis.MethodsThe study group consisted of 239 patients with proven HCC in the explanted liver at the time of liver transplant. AFP and imaging were done at referral and serially until transplant.ResultsHepatocellular carcinoma was detected before liver transplant in 78% and discovered incidentally in 22%. The cause of cirrhosis was hepatitis C (HCV) (55%), hepatitis B (HBV) (17%), alcohol (9%), and other/unknown (19%). Although AFP was elevated 62%, the median level was 15 ng/mL. Only 26%, 15% and 13% were more than 100, 400 and 1000 ng/mL, respectively. By comparison, AFP was elevated in 20% without HCC, but exceeded 100 ng/mL in only 3%. The overall accuracy of AFP was poor regardless of the cutoff. Magnetic resonance imaging was more accurate than computerized tomography or ultrasound in detecting tumour, particularly when performed within 3 months of transplant.ConclusionsMagnetic resonance imaging is most sensitive for imaging HCC and best reflects actual tumour size. AFP is insensitive and adds little to screening strategies, but has prognostic value when extremely elevated.