Hepatocellular Carcinoma in the Cirrhotic Liver: Double-Contrast MR Imaging for Diagnosis

Ward, Janice; Guthrie, J.A.; Scott, David; Atchley, J.; Wilson, Daniel J.; Davies, Mervyn H.; Wyatt, J I; Robinson, Philip

doi:10.1148/radiology.216.1.r00jl24154

Cited by 176 publications

(136 citation statements)

References 34 publications

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“…Superparamagnetic iron oxide (SPIO) particles used alone [214] or in conjunction with gadolinium-based contrast agents [215][216][217] have been shown to be highly sensitive for the detection of HCC, particularly for small tumors. The reported sensitivity of double-contrast MRI (SPIO and gadolinium) for the detection of HCC measuring 1-2 cm in diameter is 92% [215,216]. Several studies demonstrated that SPIO-enhanced MRI is useful in differentiating small HCCs from small, arterially enhancing pseudolesion [214,218].…”

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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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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“…New diagnostic parameters based on different physical and pathological alterations, such as those provided by new technologies and nonvascular agents of magnetic resonance imaging, also should be considered in the diagnostic work-up of small HCC. 4,[45][46][47][48] At present, an aggressive policy should, in our opinion, be considered if arterial hypervascularization with one technique is detected and other benign hypervascular lesions, such as hemangioma, angiomyolipoma, and focal nodular hyperplasia, are reasonably ruled out. Similarly, any new nodule in a liver with cirrhosis with a diameter of more than 2 cm should always be regarded as very suspicious for HCC, because the benign nature of nodules of this size (a situation not encountered in our series) is rare.…”

Section: The Problem Of Nodules Without Confirmation Ofmentioning

confidence: 99%

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

et al. 2005

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In a prospective study, we examined the impact of arterial hypervascularity, as established by the European Association for the Study of the Liver (EASL) recommendations, as a criterion for characterizing small (1-3 cm) nodules in cirrhosis. A total of 72 nodules (1-2 cm, n ‫؍‬ 41; 2.1-3 cm, n ‫؍‬ 31) detected by ultrasonography in 59 patients with cirrhosis were included in the study. When coincidental arterial hypervascularity was detected at contrast perfusional ultrasonography and helical computed tomography, the lesion was considered to be hepatocellular carcinoma (HCC) according to EASL criteria. When one or both techniques showed negative results, ultrasound-guided biopsy was performed. In cases with negative results for malignancy or highgrade dysplasia, biopsy was repeated when an increase in size was detected at the 3-month follow-up examination. Coincidental hypervascularity was found in 44 of 72 nodules (61%; 44% of 1-2-cm nodules and 84% of 2-3-cm nodules). Fourteen nodules (19.4%) had negative results with both techniques (hypovascular nodules). Biopsy showed HCC in 5 hypovascular nodules and in 11 of 14 nodules with hypervascularity using only one technique. All nodules larger than 2 cm finally resulted to be HCC. Not satisfying the EASL imaging criteria for diagnosis were 38% of HCCs 1 to 2 cm (17% hypovascular) and 16% of those 2 to 3 cm (none hypovascular). In conclusion, the noninvasive EASL criteria for diagnosis of HCC are satisfied in only 61% of small nodules in cirrhosis; thus, biopsy frequently is required in this setting. Relying on imaging techniques in nodules of 1 to 2 cm would miss the diagnosis of HCC in up to 38% of cases. Any nodule larger than 2 cm should be regarded as highly suspicious for HCC. (HEPATOLOGY 2005;42: 27-34.)

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“…Mostly, gadolinium-chelates are used for MRI, but hepatocyte-targeted and reticolo-endothelial system-targeted compounds are also used. Many studies have been published on the sensitivity and specificity of MRI imaging for diagnosis of HCC [3,42,54,55,57,58,60,[66][67][68][69][70][71][72] . Among studies with liver explant correlation, the sensitivity, specificity and positive predictive value ranged from 33% Andreana L et al .…”

Section: Mrimentioning

confidence: 99%

“…Among studies with liver explant correlation, the sensitivity, specificity and positive predictive value ranged from 33% Andreana L et al . Hepatocellular cancer: Imaging, histology and serum markers to 83%, from 57.1% to 100% and from 42.3% to 100% respectively [3,54,55,57,58,60,66,67,[69][70][71][72] . Studies which evaluated the sensitivity of MRI in detecting HCC, using only liver biopsy or clinical and radiological findings as gold standard, have shown an overall sensitivity, specificity and positive predictive value of 77.3% to 94.3%, 96.6% and of 92.6% to 97% respectively [42,56,68] .…”

Section: Mrimentioning

confidence: 99%

“…Studies which evaluated the sensitivity of MRI in detecting HCC, using only liver biopsy or clinical and radiological findings as gold standard, have shown an overall sensitivity, specificity and positive predictive value of 77.3% to 94.3%, 96.6% and of 92.6% to 97% respectively [42,56,68] . For MRI, the lesion-based sensitivity stratified for tumor size was 55.6% for < 2 cm in diameter; for HCC 1-2 cm in diameter it ranged from 52% to 89% [3,58,69,70] , and for HCC <1cm in diameter it ranged from 4% to 88.2% [3,[54][55][56]58,66,69,70,72] .Super paramagnetic iron oxide particles used alone [56] or combined with gadolinium-based contrast agents [66,2] are highly sensitive for the diagnosis of small HCC. Ward et al [72] found a sensitivity of 91% for HCC ≥ 1 cm and of 46% for HCC ≤ 1 cm with double-contrast MRI.…”

Section: Mrimentioning

confidence: 99%

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Surveillance and diagnosis of hepatocellular carcinoma in patients with cirrhosis

Andreana

Isgrò²,

Pleguezuelo³

et al. 2009

WJH

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Early identification of hepatocellular carcinoma (HCC) is more frequent because of surveillance programs for HCC worldwide. The optimal strategy of surveillance in cirrhosis is a current topical issue. In terms of diagnosis, recent advances in non-invasive imaging technology, including various techniques of harmonic ultrasound, new ultrasound contrast agents, multislice helical computed tomography and rapid high quality magnetic resonance, have all improved the accuracy of diagnosis. Consequently the role of liver biopsy in diagnosis of HCC has declined. The imaging diagnosis relies on the hallmark of arterial hypervascularity with portal venous washout. However, with recent advances in genomics and proteomics a great number of potential serum and tissue markers have been identified and are being developed as new candidate markers for both diagnosis and prognosis of hepatocellular carcinoma, and may increase the need for liver biopsy.

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Hepatocellular Carcinoma in the Cirrhotic Liver: Double-Contrast MR Imaging for Diagnosis

Abstract: Double-contrast MR imaging significantly improves the diagnosis of HCC compared with SPIO-enhanced and nonenhanced imaging (P <.01).

Cited by 176 publications

References 34 publications

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

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

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

Surveillance and diagnosis of hepatocellular carcinoma in patients with cirrhosis

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