Helical CT screening for hepatocellular carcinoma in patients with cirrhosis: Frequency and causes of false-positive interpretation.
Helical CT screening for hepatocellular carcinoma in patients with cirrhosis: Frequency and causes of false-positive interpretation.
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DOI：
10.2214/ajr.180.4.1801007
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发表时间：
2003-04-01
影响因子：
5
通讯作者：
Marsh, W
中科院分区：
文献类型：
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作者：
Brancatelli, G;Baron, RL;Marsh, W
OBJECTIVE.本研究的目的是确定肝硬化患者中螺旋CT对肝细胞癌的特异性。对1329例肝硬化肝移植患者进行了单排螺旋CT筛查。患者在30个月内接受了一次或多次螺旋CT检查，并随访了19个月或直至移植。我们主要使用非增强和双相对比增强技术，输注速度为2.5-5.0 mL/sec。在此期间，430例患者接受了移植。肝标本切片，在1厘米的间隔，与直接比较的成像和病理结果和组织学证实的所有病变。前瞻性术前螺旋CT报告用于初步数据分析。进行了一项回顾性非盲审查，以确定诊断为肝细胞癌的假阳性病变的特征。35例患者（8%）有肝细胞癌的螺旋CT诊断为假阳性。其中20例患者（5%）在三个螺旋CT检查阶段之一显示低密度病变。15例患者（3%）在动脉期观察到高密度病变。15个高密度病灶中，CT显示原因为短暂性肝脏良性强化（n = 3），血管瘤（n = 2），纤维化（n = 2），紫癜（n = 1），体积平均（n = 1），低度异型增生结节（n = 1），或未确定（n = 5）。在20个低衰减病变中，原因显示为纤维化（n = 8）、局灶性脂肪（n = 4）、梗死再生结节（n = 2）、再生结节（n = 1）、肝圆顶处截留的液体（n = 1）、血管瘤（n = 1）或未确定（n = 3）。18例患者中有13例（72%）的随访螺旋CT允许从肝细胞癌诊断变为无癌存在。肝硬化患者行肝细胞癌螺旋CT筛查有相当高的假阳性检出率。虽然大多数病灶呈低密度，但少数动脉期高密度病灶被证实不是肝癌。了解影像学特征和随访影像学可以帮助放射科医生避免许多患者的误诊。
OBJECTIVE. The purpose of our study was to determine the specificity of helical CT for depiction of hepatocellular carcinoma in a population of patients with cirrhosis.SUBJECTS AND METHODS. Single-detector helical CT screening was undertaken in 1329 patients with cirrhosis who were referred for transplantation. The patients underwent one or more helical CT examinations over 30 months and were followed up for an additional 19 months or until transplantation. We predominantly used unenhanced and biphasic contrast-enhanced techniques with infusions of 2.5-5.0 mL/sec. Four hundred thirty patients underwent transplantation within this period. Liver specimens were sectioned at 1-cm intervals, with direct comparison of imaging and pathologic findings and histologic confirmations of all lesions. Prospective preoperative helical CT reports were used for the primary data analysis. A retrospective unblinded review was undertaken to determine characteristics of false-positive lesions diagnosed as hepatocellular carcinoma.RESULTS. Thirty-five patients (8%) had false-positive diagnoses for hepatocellular carcinoma based on helical CT. Twenty of these patients (5%) showed hypoattenuating lesions seen during one of the three helical CT examination phases. Fifteen patients (3%) had hyper-attenuating lesions seen during the arterial phase. Among the 15 hyperattenuating lesions, CT revealed the causes to be transient benign hepatic enhancement (n = 3), hemangiomas (n = 2), fibrosis (n = 2), peliosis (n = 1), volume averaging (n = 1), low-grade dysplastic nodule (n = 1), or undetermined (n = 5). Of the 20 hypoattenuating lesions, the causes were shown to be fibrosis (n = 8), focal fat (n = 4), infarcted regenerative nodules (n = 2), regenerative nodules (n = 1), fluid trapped at the dome of the liver (n = 1), hemangioma (n = 1), or undetermined (n = 3). Follow-up helical CT in 13 (72%) of 18 patients allowed a change in the diagnosis of hepatocellular carcinoma to a finding of no cancer present.CONCLUSION. Helical CT screening for hepatocellular carcinoma in patients with cirrhosis has a substantial false-positive detection rate. Although most of lesions were hypoattenuating, a few hyperenhancing arterial phase lesions were proven not to be hepatocellular carcinoma. An awareness of imaging characteristics and follow-up imaging can help radiologists avoid a mistaken diagnosis in many patients.