Characterization of Primary and Recurrent Nodules in Liver Cirrhosis Using Contrast-Enhanced Ultrasound: Which Vascular Criteria Should Be Adopted?

Abstract

These data confirm that the HYPER-HYPO pattern at CEUS is definitely diagnostic for HCC in cirrhosis and that the HYPER-ISO pattern has a similar PPV, indicating that this pattern is highly suspicious for HCC. The ISO-ISO pattern was found in > 50% of recurrent nodules and indicates a high risk of HCC.

Cholangiocarcinoma in Cirrhosis: Value of Hepatocyte Specific Magnetic Resonance Imaging

“…Further larger studies on the latter type of lesions with special attention to the differential diagnosis with ICC rather than HCC are therefore recommended, but it has to be acknowledged that collecting such large prospective series of histologically confirmed lesions, investigated by MRI with hepatobiliary agents is quite difficult. In fact, since the rate of ICC in cirrhosis is reported to be around 1.5% of new nodules [6, 47,48] , the prospective collection of this same amount of histologically confirmed ICC lesions as in the present study (16 lesions) would have required about 1,000 patients with new nodules submitted to MRI and with subsequent biopsy. If the number of lesions to be collected is requested to be even larger than that of the present study, an enrollment of many thousands of patients submitted to MRI and histological confirmation would be necessary, which is hardly achievable even by multicentric studies.…”

Imaging of Liver Tumors in Patients with Chronic Liver Disease

“…Nevertheless, there is clear evidence from recent studies that CEUS is indeed a useful primary imaging method in the characterization of HCC and diagnostically comparable to CT/MRI for the diagnosis of a typical vascular pattern of HCC in small (\2 cm) nodules [2,3,[12][13][14]. With regard to detection of a so far unknown nodule, however, the role of CEUS is limited.…”

“…3) [3,[19][20][21]. Therefore, the question whether arterial hyperenhancement alone is sufficient for HCC diagnosis was addressed by some recent publications [3,21].…”

“…Leoni et al [3] report on 127 primary or recurrent HCC nodules (size 1-3 cm) in which they found an arterial hyperenhancement in 77.2 % of HCCs, with a washout pattern in 41 % of HCCs. Using the classical combination of arterial enhancement and portal/late phase washout (in the following termed the ''hyper-hypo pattern'') as a criterion for diagnosing HCC, the PPV was 98 %, and the accuracy was 51 %.…”

“…This is related to the washout rather than the arterial hypervascularity [3,13]. The typical vascular profile of HCC has been described and validated using extracellular contrast media in dynamic imaging; it is thus related to the specific pharmacokinetics of different contrast agents for different imaging techniques.…”