Detection of nodules in liver cirrhosis: spiral computed tomography or magnetic resonance imaging? A prospective study of 88 nodules in 34 patients

Abstract

Detection and characterization of all focal lesions in the liver are critical for screening patients with chronic liver disease. The aim of this prospective study was to investigate the accuracy of magnetic resonance imaging (MRI) and spiral computed tomography for the diagnosis of hepatic nodules in cirrhotic patients when compared with pathological findings of the explanted liver. From February 1997 to July 1999, 34 cirrhotic patients waiting for orthotopic liver transplantation (OLT) (mean age, 53.5 +/- 9.3 years; 24 males) were included. All patients had MRI and spiral computed tomography examinations, and findings were matched with the histological findings. Data analyses were made using the McNemar chi-square test. Mean time between radiological examination (MRI or spiral computed tomography) and OLT was 43.8 +/- 39 days. A total of 88 nodules were found in the 34 patients: 54 hepatocellular carcinoma (HCC) (mean size, 18 +/- 10 mm) in 21 patients, 22 dysplastic nodules (mean size, 10.7 +/- 4.3 mm) in 11 patients, and 12 macroregenerative nodules in 13 patients. Lesion-by-lesion analyses showed that sensitivity of MRI and spiral computed tomography for nodule, HCC or dysplastic nodule diagnosis was 44.3 and 31.8% (P = 0.02), 61.1 and 51.9% (P = 0.2), and 27.3 and 0% (P = 0.04), respectively. Patient-by-patient analyses showed no statistical difference between spiral computed tomography and MRI for nodule diagnosis. In conclusion, in patients with liver cirrhosis, MRI is more accurate than spiral computed tomography for the detection of liver nodules and dysplastic nodules. However, tumour size is always a restricting factor for these two techniques, which are unable to detect small HCC in more than 60% of cases.

Optimizing staging for hepatocellular carcinoma before liver transplantation: A retrospective analysis of the UNOS/OPTN database

“…In a recent single-center report comparing CT to MRI, sensitivity was 61 and 76%, respectively, for all nodules but was 100% for each modality if the lesions were Ͼ2 cm in diameter. 6 Similar results, 78% overall sensitivity with improved sensitivity (91%) for lesions Ͼ2 cm in diameter, have been reported for double-contrast MRI 8 and spiral CT 13,14 scanning. These reports, however, have 30-90 patients in their study groups, come from centers with long accumulated expertise in HCC diagnosis and treatment, and likely highlight the "state of the art" rather than the common standard of care for HCC diagnosis.…”

Is tumor biopsy necessary?

“…Eleven studies in this systematic review analyzed the accuracy of CT for the diagnosis of HCC [33][34][35]37,40,43,46,[48][49][50][51] (Supporting Table 5). Again, wide ranges were observed for the sensitivity (6%-100%) and the specificity (67%-100%), even though all studies except one 35 used the explanted liver as the gold standard.…”

“…Finally, 9 studies used MRI for the noninvasive diagnosis of HCC 32,40,43,46,48,[52][53][54][55] (Supporting Table 6). In all *The analysis was presented for 3 observers.…”

Surveillance and diagnosis of hepatocellular carcinoma in patients with cirrhosis

“…Several studies, most using correlation with explanted liver after transplantation, show that the overall sensitivity, specificity and positive predictive value of CT in diagnosis of HCC ranges from 51.9%-80.4%, 78.9%-97.9% and 88.6%-92.9% respectively [52][53][54][55][56][57][58][59][60][61][62] . Among studies that have assessed the sensitivity of CT in diagnosis of HCC and stratified for tumor size, the sensitivity for HCC < 2 cm in diameter was 61%, for HCC of 1-2 cm it ranged from 53.3% to 76% [3,53,58,59,61] , and for HCC <1 cm in diameter it ranged from 10% to 57% [3,[53][54][55][56]58,59] . CT requires intravenous iodinated contrast material and exposes patients to ionizing radiation.…”