Prospective comparative study of spiral computer tomography and magnetic resonance imaging for detection of hepatocellular carcinoma

Abstract

Background: Hepatocellular carcinoma (HCC) is often detected at a relatively late stage when tumour size prohibits curative surgery. Screening to detect HCC at an early stage is performed for patients at risk. Aim: The aim of this study was to compare prospectively the diagnostic accuracy and classification for management of the two state of the art secondline imaging techniques: triphasic spiral computer tomography (CT) and super paramagnetic iron oxide (SPIO) enhanced magnetic resonance imaging (MRI). Patients: Sixty one patients were evaluated between January 1996 and January 1998. Patients underwent CT and MRI within a mean interval of 6.75 days. Methods: CT and MRI were evaluated blindly for the presence and number of lesions, characterisation of these lesions, and classification for management. For comparison of the data on characterisation, the CT and MRI findings were compared with histopathological studies of the surgical specimens and/or follow up imaging. Data of patients not lost to follow up were available to January 2001. Results: SPIO enhanced MRI detected more lesions and overall smaller lesions than triphasic spiral CT (number of lesions 189 v 124; median diameter 1.0 v 1.8 cm; Spearman rank's correlation coefficient 0.63, p<0.001). There was no significant difference in accuracy between CT and MRI for lesion characterisation. The agreement in classification for management was very good (weighted kappa 0.91, 95% CI 0.83-0.99). Conclusion: SPIO enhanced MRI detects more and smaller lesions, but both techniques are comparable in terms of classification for management. SPIO enhanced MRI may be preferred as there is no exposure to ionising radiation.

Selection of patients with hepatocellular carcinoma for liver transplantation

“…However, when preoperative liver imaging is compared with pathological findings, the sensitivity of Lipiodol CT is only 53 per cent 46 , and up to 10 per cent of patients who undergo liver transplantation for chronic liver disease will have incidental tumours in the explanted liver 4,47 . Recent studies have suggested that MRI is better than CT in detecting HCC (sensitivities of 76 versus 61 per cent), particularly for tumours 1-2 cm in diameter 46,48,49 . However, there is no effective method for detecting tumours less than 1 cm in diameter; MRI fails to identify these lesions in approximately two-thirds of patients 46 .…”

“…A recent study suggested that by excluding patients with poorly differentiated tumours using routine tumour biopsy, it may be possible to reduce recurrence after transplantation to less than 10 per cent 48 . In this series, there were no biopsy-related complications and 5-year actuarial and recurrence-free survival was 75 and 92 per cent respectively 48 . Although this is the only study to examine the role of tumour biopsy in the transplant setting, the initial results are encouraging.…”

Liver transplantation and expanded Milan criteria: does it really work?

“…By contrast, the MC, UCSF and Onaca et al (42) proposal rely on factors (tu- ITT = intention to treat ¥ = patient survival (PS) ² = recurrence free rate (RR) Staging refers to the method used for tumor staging. P = pretransplant radiology; R = explant tumor pathology; NA = not available mor size and number) that can be determined by preoperative imaging, however, such criteria must consider the limitations of imaging studies (7,23,48,55,56,59,60) . The continued improvement in imaging techniques may decrease the gap between imaging and pathology of HCC, although some understanding will certainly continue to exist (53) .…”

Hepatocellular nodules in cirrhosis: Focus on diagnostic criteria on liver biopsy. A Western experience

“…In doubtful cases, nuclear crowding is ascertained by semiquantitative analysis showing an increased cellularity, which should be at least twice as that seen in the surroundings. 15 Unpaired arteries (Fig. 1M): intraparenchymal arterioles unassociated to portal tracts.…”

“…1 Major progresses in their identification and understanding were provided by imaging evaluation in vivo, making possible the sampling of small early lesions (0.5-2 cm) and to follow their natural history. [2][3][4][5][6][7][8][9][10][11][12][13][14][15][16][17] Most of the advances in the field have been achieved through the systematic macro-and microscopical examination of native transplanted end-stage cirrhotic livers; however, there is a substantial lack of information on the morphological features of ultrasound (US)-detected hepatocellular nodules on liver biopsies. Indeed, the differential diagnosis of these lesions, while relatively easy on surgical specimens, is a challenging one on small liver biopsies, even for experienced hepatopathologists.…”