Characteristics of hepatocellular carcinoma nodules newly detected by computed tomography during arteriography and arterial portography: preliminary report of a randomized controlled trial
Characteristics of hepatocellular carcinoma nodules newly detected by computed tomography during arteriography and arterial portography: preliminary report of a randomized controlled trial
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DOI：
10.1007/s12072-011-9310-y
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发表时间：
2012-06
影响因子：
6.6
通讯作者：
Takamasa Ohki;R. Tateishi;M. Akahane;S. Shiina;N. Yamashiki;S. Mikami;K. Enooku;Eriko Goto;Ryota Masuzaki;Yuji Kondo;T. Goto;Shinichi Inoo;K. Ohtomo;M. Omata;H. Yoshida;K. Koike
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文献类型：
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作者：
Takamasa Ohki;R. Tateishi;M. Akahane;S. Shiina;N. Yamashiki;S. Mikami;K. Enooku;Eriko Goto;Ryota Masuzaki;Yuji Kondo;T. Goto;Shinichi Inoo;K. Ohtomo;M. Omata;H. Yoshida;K. Koike
背景和目的本研究是一项正在进行的随机对照试验的一部分，该试验旨在研究计算机断层扫描（CT）在肝动脉造影和动脉门静脉造影（CTHA/CTAP）中作为小肝细胞癌（HCC）患者治疗前检查的作用。方法选取动态CT诊断为动脉期高衰减、平衡期低衰减、Child-Pugh A级、3个及以下肿瘤直径≤3.0 cm的HCC患者137例，随机选择行CTHA/CTAP。我们比较了CTHA/CTAP和动态CT的诊断价值。采用逐步变量选择进行单因素和多因素logistic回归分析，以确定与检测额外结节相关的因素。结果动态增强CT诊断时hcc总数为197个。与动态CT相比，45例（32.8%）患者在CTHA/CTAP上额外诊断为肝癌，结节75个，平均直径8.7 mm（范围2-20）。回顾性分析显示，54个结节可以在先前的动态CT动脉或平衡期被识别，而21个无法识别。多因素logistic回归分析显示，动态CT多结节性[比值比(OR) = 5.35，P= 0.002]、复发病例与首发病例（OR = 2.16，P= 0.06）、乙型肝炎表面抗原血清阴性（OR = 10.0，P= 0.03）与附加结节的检出相关。结论ctha /CTAP可用于多结节性HCC患者、复发病例和乙型肝炎表面抗原阴性患者经皮消融前检测附加结节。
Background and aimsThis study was part of an on-going randomized controlled trial to investigate the utility of computed tomography (CT) during hepatic arteriography and arterial portography (CTHA/CTAP) as a pre-treatment examination for patients with small hepatocellular carcinoma (HCC).MethodsA total of 137 patients with HCC who were diagnosed by dynamic CT showing hyperattenuation in the arterial phase and hypoattenuation in the equilibrium phase, were Child–Pugh class A, and had three or less tumors with diameters ≤ 3.0 cm were randomly assigned to undergo CTHA/CTAP. We compared the diagnostic utilities of CTHA/CTAP and dynamic CT. Univariate and multivariate logistic regression analyses with stepwise variable selection were performed to identify factors related to the detection of additional nodules.ResultsThe total number of HCCs at the time of diagnosis with contrast-enhanced dynamic CT was 197. 75 nodules with a mean diameter of 8.7 mm (range 2–20) in 45 patients (32.8%) were additionally diagnosed as definite HCC on CTHA/CTAP compared with dynamic CT. A retrospective review revealed that 54 nodules could have been identified on arterial or equilibrium phase of the previous dynamic CT, whereas 21 were indiscernible. Multivariate logistic regression analysis revealed that multinodularity on dynamic CT [odds ratio (OR) = 5.35,P= 0.002], recurrent case as opposed to initial case (OR = 2.16,P= 0.06), and seronegativity for hepatitis B surface antigen (OR = 10.0,P= 0.03) were associated with the detection of additional nodules.ConclusionCTHA/CTAP may be useful for detecting additional nodules prior to percutaneous ablation in patients with multinodular HCC on dynamic CT, in recurrent cases, and in hepatitis B surface antigen-negative cases.