Characterization of small nodules in cirrhosis by assessment of vascularity: The problem of hypovascular hepatocellular carcinoma

Bolondi, Luigi; Gaiani, Stefano; Celli, Natascia; Golfieri, Rita; Grigioni, Francesco; Leoni, Simona; Venturi, Anna Maria; Piscaglia, Fabio

doi:10.1002/hep.20728

Cited by 404 publications

(344 citation statements)

References 50 publications

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Section: F E D C B Amentioning

confidence: 98%

“…Another recent study showed that the detection rate by coincident arterial hyper-vascularity at CEUS and CT was 44% in nodules of 1 to 2 cm, compared with 84% in larger nodules of sizes 2 to 3 cm in cirrhotic liver [39] . Relying on imaging techniques in nodules of 1 to 2 cm, the missed diagnosis of HCC was up to 38% [39] . This evidence showed that the diagnosis of nodules of 1 to 2 cm in cirrhotic patients is not satisfactory even with arterial hyper-vascularity shown by CEUS and CT. Late-phase pulse-inversion CEUS improved diagnostic sensitivity from 85% to 100% and specificity from 30% to 63% compared with BUS, and with lower inter-observer variability, for the discrimination of malignant versus benign liver lesions [40] .…”

Section: F E D C B Amentioning

confidence: 98%

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Detection of focal liver lesions in cirrhotic liver using contrast-enhanced ultrasound

Wong

Xu²,

Xie³

2009

WJR

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Patients with liver cirrhosis are at increased risk of hepatocellular carcinoma (HCC). Conventional or baseline ultrasound (BUS) is often used as the first-line tool for HCC surveillance or detection, but the accuracy of BUS in HCC detection or differentiation from other focal liver lesions (FLLs) is limited. Contrast-enhanced ultrasound (CEUS) represents a recent revolution in the field of ultrasonography and it has become increasingly important in the detection and evaluation of FLLs. In CEUS, HCC typically exhibits arterial hyper-enhancement and portal-venous washout represented by hypoenhanced lesions in the portal venous and late phases. The detection rate of HCC was significantly higher with CEUS compared with BUS. Even regenerative or some dysplastic nodules may exhibit arterial hyperenhancement as they are differentiated from HCC by its iso-enhancing pattern in portal and late phases. The contrast-enhancement patterns of other different types of benign and malignant FLLs, as well as their detection rates with CEUS, were also discussed.

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Section: F E D C B Amentioning

confidence: 98%

Section: F E D C B Amentioning

confidence: 98%

Detection of focal liver lesions in cirrhotic liver using contrast-enhanced ultrasound

Wong

Xu²,

Xie³

2009

WJR

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“…Indeed, the noninvasive diagnostic criteria based on arterial hypervascularization in contrast-enhanced imaging techniques, published by the European Association for the study of the liver (EASL), are satisfied in only 61% of small nodules in cirrhosis [223]. Furthermore, imaging of 1-to 2-cm nodules would miss the diagnosis of HCC in up to 38% of cases.…”

Section: Ct Mri and Other Imaging Modalitiesmentioning

confidence: 99%

Asian Pacific Association for the Study of the Liver consensus recommendations on hepatocellular carcinoma

et al. 2010

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Introduction The Asian Pacific Association for the Study of the Liver (APASL) convened an international working party on the management of hepatocellular carcinoma (HCC) in December 2008 to develop consensus recommendations. Methods The working party consisted of expert hepatologist, hepatobiliary surgeon, radiologist, and oncologist from Asian-Pacific region, who were requested to make drafts prior to the consensus meeting held at Bali, Indonesia on 4 December 2008. The quality of existing evidence and strength of recommendations were ranked from 1 (highest) to 5 (lowest) and from A (strongest) to D (weakest), respectively, according to the Oxford system of evidence-based approach for developing the consensus statements. 123Hepatol Int (2010) 4: 439-474 DOI 10.1007/s12072-010-9165-7 Results Participants of the consensus meeting assessed the quality of cited studies and assigned grades to the recommendation statements. Finalized recommendations were presented at the fourth APASL single topic conference on viral-related HCC at Bali, Indonesia and approved by the participants of the conference.

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“…Several other imaging features can be used to distinguish HCC from other liver lesions: portal vein invasion, abnormal internal vessels [3,25], heterogeneous enhancement [3], large size [7], hyperintensity on T2 MRI sequences, and a pseudocapsule with delayed enhancement [26] all favor a diagnosis of HCC. Our findings should be confirmed with a prospective study, where the HAC and PVC are considered in the context of all of the other imaging and clinical data.…”

Section: Discussionmentioning

confidence: 99%

“…A minority of well-differentiated HCCs are hypodense to the liver on all phases [7]. Some hypervascular HCCs do not have washout [8].…”

Section: Introductionmentioning

confidence: 99%

Classification of Hypervascular Liver Lesions Based on Hepatic Artery and Portal Vein Blood Supply Coefficients Calculated from Triphasic CT Scans

Boas

Kamaya

et al. 2014

J Digit Imaging

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Perfusion CT of the liver typically involves scanning the liver at least 20 times, resulting in a large radiation dose. We developed and validated a simplified model of tumor blood supply that can be applied to standard triphasic scans and evaluated whether this can be used to distinguish benign and malignant liver lesions. Triphasic CTs of 46 malignant and 32 benign liver lesions were analyzed. For each phase, regions of interest were drawn in the arterially enhancing portion of each lesion, as well as the background liver, aorta, and portal vein. Hepatic artery and portal vein blood supply coefficients for each lesion were then calculated by expressing the enhancement curve of the lesion as a linear combination of the enhancement curves of the aorta and portal vein. Hepatocellular carcinoma (HCC) and hypervascular metastases, on average, both had increased hepatic artery coefficients compared to the background liver. Compared to HCC, benign lesions, on average, had either a greater hepatic artery coefficient (hemangioma) or a greater portal vein coefficient (focal nodular hyperplasia or transient hepatic attenuation difference). Hypervascularity with washout is a key diagnostic criterion for HCC, but it had a sensitivity of 72 % and specificity of 81 % for diagnosing malignancy in our diverse set of liver lesions. The sensitivity for malignancy was increased to 89 % by including enhancing lesions that were hypodense on all phases. The specificity for malignancy was increased to 97 % (p=0.039) by also examining hepatic artery and portal vein blood supply coefficients, while maintaining a sensitivity of 76 %.

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Characterization of small nodules in cirrhosis by assessment of vascularity: The problem of hypovascular hepatocellular carcinoma

Cited by 404 publications

References 50 publications

Detection of focal liver lesions in cirrhotic liver using contrast-enhanced ultrasound

Detection of focal liver lesions in cirrhotic liver using contrast-enhanced ultrasound

Asian Pacific Association for the Study of the Liver consensus recommendations on hepatocellular carcinoma

Classification of Hypervascular Liver Lesions Based on Hepatic Artery and Portal Vein Blood Supply Coefficients Calculated from Triphasic CT Scans

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