Coarse Nodular US Pattern in Hepatic Cirrhosis: Risk for Hepatocellular Carcinoma

Caturelli, Eugenio; Castellano, Luigi; Fusilli, Saverio; Palmentieri, Bruno; Niro, Grazia; Vecchio-Blanco, C. Del; Andriulli, Angelo; Sio, Ilario de

doi:10.1148/radiol.2263011737

Cited by 37 publications

(40 citation statements)

References 29 publications

(30 reference statements)

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“…Studies in the literature have demonstrated that steatosis is associated with a rapid progression of the hepatic fibrosis and a poor response to the antiviral therapy in hepatitis C patients (27,28) . A precise measurement of the hepatic parenchyma attenuation coefficients is essential for determining a patient's eligibility for a living-donor transplant.…”

Section: Discussionmentioning

confidence: 99%

O valor da fase sem contraste na tomografia computadorizada do abdome

et al. 2008

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OBJECTIVE: To determine the role of the unenhanced phase of abdominal computed tomography in patients without a definite diagnosis or undergoing tumor staging. MATERIALS AND METHODS: A prospective and transversal study was developed with 100 consecutive patients submitted to unenhanced and contrastenhanced abdominal computed tomography. Two observers evaluated all the computed tomography images in the contrast-enhanced phase (first analysis) and, later, in the unenhanced phase (second analysis) in an attempt to establish the primary and secondary diagnoses as a function of the clinical indication for the study. The frequency of changes in the diagnoses resulting from a combined analysis of the images in the pre-and post-contrast phases was evaluated. Cases with changes in the diagnosis were reviewed by clinical specialists for determining possible changes in the therapeutic approach. RESULTS: Primary and secondary diagnoses were changed in respectively 1 and 18 cases (p = 1.000; p = 0.143) as follows: steatosis, adrenal nodules, nephrolithiasis, renal cysts and hepatic calcification. In the cases where the unenhanced phase changed the diagnosis, the specialists changed the therapeutic approach in 14 of the 19 patients (73%) (p = 0.038). CONCLUSION: No significant change was observed in the primary or secondary diagnosis as a result of the findings in the unenhanced phase. However, changes in secondary diagnoses affected the therapeutic approach adopted by the specialists. Keywords: Computed tomography; Contrast media; Abdomen.OBJETIVO: Determinar o valor agregado da fase sem meio de contraste da tomografia computadorizada do abdome em pacientes sem diagnóstico determinado ou em estadiamento tumoral. MATERIAIS E MÉTODOS: Estudo prospectivo e transversal em 100 pacientes consecutivos submetidos a tomografia computadorizada abdominal sem e com meio de contraste intravenoso. Dois examinadores avaliaram todos os exames, procurando estabelecer, através da fase com meio de contraste intravenoso (primeira análise) e posteriormente através da fase sem contraste (segunda análise), o diagnóstico principal e os secundários em função da indicação clínica do exame. Mediu-se a freqüência de mudança diagnóstica decorrente da análise combinada das fases pré-e pós-contraste intravenoso. Casos que tiveram mudança diagnóstica foram avaliados por especialistas clínicos para determinar se implicaria mudanças de conduta. RESULTADOS: Diagnósticos principal e secundário foram modificados em 1 e 18 casos, respectivamente (p = 1,000; p = 0,143). Os diagnósticos modificados foram: esteatose, definição de nódulo em adrenal, nefrolitíase, classificação de cistos renais e calcificação hepática. Nos casos em que a fase sem contraste modificou o diagnóstico, os especialistas mudaram sua conduta em 14/19 (73%) dos pacientes (p = 0,038). CONCLUSÃO: A fase sem contraste não modificou significativamente o diagnóstico principal ou secundário. Porém, as mudanças nos diagnós-ticos secundários influenciaram na conduta adotada pelos especialistas. Unite...

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Section: Discussionmentioning

confidence: 99%

O valor da fase sem contraste na tomografia computadorizada do abdome

et al. 2008

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“…To reduce interobserver variability of both operators, a set of standard images with H, BL, C, and CSNP was used to assess echo patterns as in Caturelli's work and Kitamura's work figures for the CLNP [11,14].…”

Section: Abdominal Ultrasound Ultrasound (Us) Examinationsmentioning

confidence: 99%

“…Therefore, other indicators to select patients who may have a higher risk of progression in HCC are necessary [10]. Retrospective studies indicate that the coarse nodular pattern is a risk factor for the development of HCC [11][12][13][14][15]. Coarse echo pattern is the most common one found in liver cirrhosis (LC) [11]; it is defined coarse nodular by the detection within the liver of small multiple hypoechoic nodular images (<1 cm) at US.…”

Section: Introductionmentioning

confidence: 99%

“…Retrospective studies indicate that the coarse nodular pattern is a risk factor for the development of HCC [11][12][13][14][15]. Coarse echo pattern is the most common one found in liver cirrhosis (LC) [11]; it is defined coarse nodular by the detection within the liver of small multiple hypoechoic nodular images (<1 cm) at US. A coarse large nodular pattern (CLNP) presents nodules >5 mm, while in a coarse small nodular pattern (CSNP) nodules are <5 mm [11][12][13][14][15].…”

Section: Introductionmentioning

confidence: 99%

“…Coarse echo pattern is the most common one found in liver cirrhosis (LC) [11]; it is defined coarse nodular by the detection within the liver of small multiple hypoechoic nodular images (<1 cm) at US. A coarse large nodular pattern (CLNP) presents nodules >5 mm, while in a coarse small nodular pattern (CSNP) nodules are <5 mm [11][12][13][14][15]. Histological studies on cirrhotic liver have shown the risk of evolution of these macronodules in HCC [16].…”

Section: Introductionmentioning

confidence: 99%

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644 Surveillance Program for Diagnosis of HCC in Liver Cirrhosis: Role of Ultrasound Echopatterns

Soresi¹,

Giannitrapani²,

Campagna³

et al. 2013

Journal of Hepatology

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International guidelines suggest ultrasound surveillance for hepatocellular carcinoma (HCC) early diagnosis in liver cirrhosis (LC) patients, but 40% of nodules <2 cm escape detection. We investigated the existence of an ultrasound pattern indicating a higher risk of developing HCC in patients under surveillance. 359 patients with LC (Child-Pugh A-B8) underwent ultrasound screening (median follow-up 54 months, range 12-90 months), liver function tests, alpha-fetoprotein assay, and portal hypertension evaluation. Echo patterns were homogeneous, bright liver, coarse, coarse small nodular pattern, and coarse large nodular pattern. During follow-up 13.9% developed HCC. At multivariate analysis using Cox's model alpha-fetoprotein, coarse large nodular pattern, portal hypertension, and age were independent predictors of HCC development. Kaplan-Meier estimates of HCC cumulative risk in relation to the baseline echo patterns showed risk of 75% in coarse large nodular pattern patients, 23% coarse small nodular pattern, 21% coarse pattern, 0% homogeneous, and bright liver echo patterns (log-rank test = 23.6, < 0.001). Coarse large nodular pattern indicates a major risk factor for HCC as 40.7% of patients with this pattern developed HCC. Homogeneous and bright liver echo patterns and the absence of portal hypertension were not related to HCC. This observation could raise the question of possibly modifying the follow-up timing in this subset of patients.

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Long‐Term Study of Hepatitis Delta Virus Infection at Secondary Care Centers: The Impact of Viremia on Liver‐Related Outcomes

et al. 2020

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BaCKgRoUND aND aIMS: Hepatitis delta virus (HDV) infection is associated with fast progression to liver cirrhosis and liver complications. Previous studies have, however, been mainly from tertiary care centers, with risk for referral bias toward patients with worse outcomes. Furthermore, the impact of HDV viremia per se on liver-related outcomes is not really known outside the human immunodeficiency virus co-infection setting. We have therefore evaluated the long-term impact of HDV viremia on liver-related outcomes in a nationwide cohort of patients with hepatitis B and D co-infection, cared for at secondary care centers in Sweden. appRoaCH aND ReSUltS: In total, 337 patients with anti-HDV positivity, including 233 patients with HDV RNA viremia and 91 without HDV viremia at baseline, were retrospectively studied, with a mean follow-up of 6.5 years (range, 0.5-33.1). The long-term risks for liver-related events (i.e., hepatocellular carcinoma [HCC], hepatic decompensation, or liver-related death/transplantation) were assessed, using Cox regression analysis. The risk for liver-related events and HCC was 3.8-fold and 2.6-fold higher, respectively, in patients with HDV viremia compared with those without viremia, although the latter was not statistically significant. Among patients with HDV viremia with no baseline cirrhosis, the cumulative risk of being free of liver cirrhosis or liver-related events was 81.9% and 64.0% after 5 and 10 years of follow-up, respectively. This corresponds to an incidence rate of 0.04 cases per person-year. CoNClUSIoNS: HDV RNA viremia is associated with a 3.8-fold higher risk for liver-related outcomes. The prognosis was rather poor for patients with HDV viremia without cirrhosis at baseline, but it was nevertheless more benign than previous estimates from tertiary centers. Our findings may be of importance when making decisions about treatment and evaluating potential outcomes of upcoming antivirals against HDV. (Hepatology 2020;72:1177-1190). H epatitis delta virus (HDV) is considered to cause the most severe form of chronic viral hepatitis, with fast progression to liver cirrhosis and liver complications. (1,2) Previous studies evaluating the natural course of HDV infection have, however, been mainly from tertiary centers, with risk for referral bias toward patients with worse outcomes. (3-7) Published data on the rate of liver disease progression in patients with HDV viremia without cirrhosis are scarce, and knowledge of the outcomes in an unbiased population is lacking.

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Coarse Nodular US Pattern in Hepatic Cirrhosis: Risk for Hepatocellular Carcinoma

Abstract: The coarse nodular pattern is more often seen in patients with HDV-related cirrhosis, and, in this setting (in contrast to HBV-, HCV-, and ALC-related cirrhosis, as well as in PBC), it does not represent an added risk factor for HCC.

Cited by 37 publications

References 29 publications

O valor da fase sem contraste na tomografia computadorizada do abdome

O valor da fase sem contraste na tomografia computadorizada do abdome

644 Surveillance Program for Diagnosis of HCC in Liver Cirrhosis: Role of Ultrasound Echopatterns

Long‐Term Study of Hepatitis Delta Virus Infection at Secondary Care Centers: The Impact of Viremia on Liver‐Related Outcomes

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