Imaging detection of new HCCs in cirrhotic patients treated with different techniques: Comparison of conventional US, spiral CT, and 3-dimensional contrast-enhanced US with the Navigator technique (Nav 3D CEUS)

Abstract

Introduction: The commercially available Navigator system ª (Esaote, Italy) allows easy 3D reconstruction of a single 2D acquisition of contrast-enhanced US (CEUS) imaging of the whole liver (with volumetric correction provided by the electromagnetic device of the Navigator ª ). The aim of our study was to compare the efficacy of this panoramic technique (Nav 3D CEUS) with that of conventional US and spiral CT in the detection of new hepatic lesions in patients treated for hepatocellular carcinoma (HCC). Materials and methods: From November 2006 to May 2007, we performed conventional US, Nav 3D CEUS, and spiral CT on 72 cirrhotic patients previously treated for 1 or more HCCs (M/F: 38/34; all HCV-positive; Child: A/B 58/14) (1 examination: 48 patients; 2 examinations: 20 patients; 3 examinations: 4 patients). Nav 3D CEUS was performed with SonoVue ª (Bracco, Milan, Italy) as a contrast agent and Technos MPX ª scanner (Esaote, Genoa, Italy). Sensitivity, specificity, diagnostic accuracy, and positive and negative predictive values (PPV and NPV, respectively) were evaluated. Differences between the techniques were assessed with the chi-square test (SPSS release-15). Results: Definitive diagnoses (based on spiral CT and additional follow-up) were: 6 cases of local recurrence (LocRecs) in 4 patients, 49 new nodules >2 cm from a treated nodule (NewNods) in 34 patients, and 10 cases of multinodular recurrence consisting of 4 or more nodules (NewMulti). The remaining 24 patients (22 treated for 1e3 nodules, 2 treated for >3 nodules) remained recurrence-free. Conventional US correctly detected 29/49 NewNods, 9/10 NewMultis, and 3/6 LocRecs (sensitivity: 59.2%; specificity: 100%; diagnostic accuracy: 73.6%; PPV: 100%; NPV: 70.1%). Spiral CT detected 42/49 NewNods plus 1 that was a false positive, 9/10 NewMultis, and all 6 LocRecs (sensitivity: 85.7%; specificity: 95.7%; diagnostic accuracy: 90.9%; PPV: 97.7%; NPV: 75.9%). 3D NAV results were: 46N (þ9 multinodularN and 6 LR), 3 falsenegatives, and one false-positive (sensitivity: 93.9; specificity: 97.9%; diagnostic accuracy: 95.6; PPV: 97.9; NPV: 93.9). Conclusions: 3D Nav CEUS is significantly better than US and very similar to spiral CT for detection of new HCCs. This technique revealed the presence of lesions that could not be visualized with spiral CT.Sommario Introduzione: Il sistema ''Navigator ª '' di Esaote consente di ottenere ricostruzioni 3-D di tutto il fegato (corrette volumetricamente da un sistema di guida) mediante singola acquisizione con CEUS (mediante scansione perpendicolare all'asse lungo del fegato, per una completa acquisizione 2-D del suo asse corto) e sovrappone tali ricostruzioni 3-D con quelle ottenute con la TC. Scopo: valutare la capacità di tale sistema di diagnosticare nuovi HCC rispetto all'US e alla TC in una popolazione di HCC su cirrosi precedentemente trattati con varie metodiche. Materiali e metodi: Settantadue cirrotici con pregressi HCC (M/F: 38/34; tutti HCV þvi, Child A/B: 58/14, con detection di 49 nuovi noduli (N) in 34...

Two-Phase MDCT Protocol for the Screening of Small Hepatocellular Carcinoma

“…Studies in the literature have shown the superiority of CT over ultrasound in certain screening situations [ 6 , 8 ]. In patients that had been previously treated for HCC, an article by Giangregorio et al showed that the sensitivity of conventional US was much lower than that of MDCT for the detection of new HCC nodules [ 18 ]. Another possibility is for MDCT to be used alternately with ultrasound every 6 months.…”

3D versus 2D contrast-enhanced sonography in the evaluation of therapeutic response of hepatocellular carcinoma after locoregional therapies: preliminary findings

“…To this regard, 3D CEUS is more similar to MRI and CT, and further studies are needed to evaluate the improvement in spatial and temporal resolution provided by the recently introduced new electronic matrix probes. Despite lacking real-time features, 3D CEUS appears to be promising in the calculation of tumor volume, definition of spatial geometry, and in detecting new foci of HCC occurring in patients already treated by means of LRT [8,17,18].…”