Hepatocellular carcinoma: evaluation with biphasic, contrast-enhanced, helical CT.

Baron, Richard L.; Oliver, James H.; Dodd, Gerald D.; Nalesnik, Michael A.; Holbert, B L; Carr, Brian I.

doi:10.1148/radiology.199.2.8668803

Cited by 347 publications

(174 citation statements)

References 14 publications

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“…Histopathological studies have demonstrated a progressive increase in the arterial supply to nodules evolving toward malignancy, [28][29][30] providing the clues for the clinical diagnosis with imaging techniques. 20,[31][32][33][34][35] To give a solid basis for the noninvasive diagnosis, the EASL panel of experts determined that this pattern must be confirmed by two different imaging techniques in nodules larger than 2 cm. No reference was made to vascularity for nodules between 1 and 2 cm, and it was pointed out that these lesions require histopathological investigation.…”

Section: Discussionmentioning

confidence: 99%

Characterization of Small Nodules in Cirrhosis by Assessment of Vascularity: The Problem of Hypovascular Hepatocellular Carcinoma *

et al. 2005

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In a prospective study, we examined the impact of arterial hypervascularity, as established by the European Association for the Study of the Liver (EASL) recommendations, as a criterion for characterizing small (1-3 cm) nodules in cirrhosis. A total of 72 nodules (1-2 cm, n ‫؍‬ 41; 2.1-3 cm, n ‫؍‬ 31) detected by ultrasonography in 59 patients with cirrhosis were included in the study. When coincidental arterial hypervascularity was detected at contrast perfusional ultrasonography and helical computed tomography, the lesion was considered to be hepatocellular carcinoma (HCC) according to EASL criteria. When one or both techniques showed negative results, ultrasound-guided biopsy was performed. In cases with negative results for malignancy or highgrade dysplasia, biopsy was repeated when an increase in size was detected at the 3-month follow-up examination. Coincidental hypervascularity was found in 44 of 72 nodules (61%; 44% of 1-2-cm nodules and 84% of 2-3-cm nodules). Fourteen nodules (19.4%) had negative results with both techniques (hypovascular nodules). Biopsy showed HCC in 5 hypovascular nodules and in 11 of 14 nodules with hypervascularity using only one technique. All nodules larger than 2 cm finally resulted to be HCC. Not satisfying the EASL imaging criteria for diagnosis were 38% of HCCs 1 to 2 cm (17% hypovascular) and 16% of those 2 to 3 cm (none hypovascular). In conclusion, the noninvasive EASL criteria for diagnosis of HCC are satisfied in only 61% of small nodules in cirrhosis; thus, biopsy frequently is required in this setting. Relying on imaging techniques in nodules of 1 to 2 cm would miss the diagnosis of HCC in up to 38% of cases. Any nodule larger than 2 cm should be regarded as highly suspicious for HCC. (HEPATOLOGY 2005;42: 27-34.)

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Section: Discussionmentioning

confidence: 99%

Characterization of Small Nodules in Cirrhosis by Assessment of Vascularity: The Problem of Hypovascular Hepatocellular Carcinoma *

et al. 2005

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“…Tumors greater than 1 cm in size have a sensitivity greater than 90%. 49,[50][51][52][53][54] In general, sensitivity of contrast-enhanced CT (without the triple phase) ranges from 53%to 95%. 34,[47][48][49]51,53,55 A CT scan's specificity in detecting HCC is approximately 94%.…”

Section: Screening Sensitivity and Specificitymentioning

confidence: 99%

“…49,[50][51][52][53][54] In general, sensitivity of contrast-enhanced CT (without the triple phase) ranges from 53%to 95%. 34,[47][48][49]51,53,55 A CT scan's specificity in detecting HCC is approximately 94%. 34,[47][48][49]51,53,55 The gold standard for serological and radiological screening tests for HCC is based on longitudinal follow-up and tissue diagnosis (biopsy, surgical resection, and transplant explant).…”

Section: Screening Sensitivity and Specificitymentioning

confidence: 99%

“…34,[47][48][49]51,53,55 A CT scan's specificity in detecting HCC is approximately 94%. 34,[47][48][49]51,53,55 The gold standard for serological and radiological screening tests for HCC is based on longitudinal follow-up and tissue diagnosis (biopsy, surgical resection, and transplant explant). 34,48 False-negative results may arise if the size of the tumor is less than the level of detection of the screening modality.…”

Section: Screening Sensitivity and Specificitymentioning

confidence: 99%

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Hepatocellular carcinoma screening in patients waiting for liver transplantation: A decision analytic model

Saab

Ly²,

Nieto

et al. 2003

Liver Transplantation

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“…HCC nodules were detected by two imaging modalities consisting of US and MDCT. The diagnosis of HCC was confirmed using US-guided fine-needle biopsy specimens or from typical findings observed during MDCT (hyperattenuation area at the hepatic arterial phase, and hypoattenuation at the delayed phase) [17,18]. Of these 364 patients, 67 consecutive patients diagnosed with HCC for the first time were enrolled in this study, and these patients underwent CTAP and CTHA during admission, within 4 weeks following MDCT.…”

Section: Patientsmentioning

confidence: 99%

Outcome of small liver nodules detected by computed tomographic angiography in patients with hepatocellular carcinoma

et al. 2010

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Purpose Hepatic lesions identified by computed tomography (CT) during arterial portography (CTAP) or CT hepatic arteriography (CTHA) in hepatocellular carcinoma (HCC) patients are sometimes too small to be diagnosed as HCC. We undertook this cohort study to assess whether these small lesions are actually HCC, and to clarify the effectiveness of these imaging examinations in a clinical setting. Methods We assessed the characteristics of 74 tiny lesions detected by CTAP and/or CTHA, but not by CT in 67 patients. Results Seven out of 10 nodules were histologically confirmed as HCC and 18 out of 64 lesions increased in size and showed typical findings of HCC during the followup period. Multivariate analysis revealed that the size of the main tumor ([30 mm in diameter) was associated with the presence of tiny additional HCC lesions (P = 0.002). Conclusions These findings indicate that CTAP and CTHA are recommended for determining the stage of HCC, especially when the HCC nodule is larger than 30 mm in diameter.

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Hepatocellular carcinoma: evaluation with biphasic, contrast-enhanced, helical CT.

Abstract: Use of both HAP and PVP contrast-enhanced CT optimizes the evaluation of patients with or at risk for HCC.

Cited by 347 publications

References 14 publications

Characterization of Small Nodules in Cirrhosis by Assessment of Vascularity: The Problem of Hypovascular Hepatocellular Carcinoma *

Characterization of Small Nodules in Cirrhosis by Assessment of Vascularity: The Problem of Hypovascular Hepatocellular Carcinoma *

Hepatocellular carcinoma screening in patients waiting for liver transplantation: A decision analytic model

Outcome of small liver nodules detected by computed tomographic angiography in patients with hepatocellular carcinoma

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