Systematic review of radiological imaging for hepatocellular carcinoma in cirrhotic patients

Abstract

We systematically reviewed the evidence for determining the best radiological imaging for characterizing hepatocellular carcinoma (HCC) in cirrhotic patients in 997 articles between 1995 and 2001. We selected only prospective and retrospective cohorts of patients, excluding both case reports and studies without separate data on HCC. Only 29 studies, comprising 918 patients, fulfilled the inclusion criteria: 10 used the explanted liver as the reference standard of diagnosis. All except one, either found no statistically significant difference between imaging modalities or had no direct comparison of sensitivity between different modalities of imaging; 16 studies evaluated HCC among cirrhotic patients and had biopsy or imaging as the reference standard for diagnosis. However, no one imaging technique was shown to be superior. In two studies, data of a HCC subgroup was derived from the studies evaluating different kinds of focal hepatic lesions. No conclusion could be drawn because of the small sample size. One study addressed the issue of therapeutic impact. The evidence for choosing the best modality of imaging for characterizing HCC in cirrhotic patients is inadequate. Large multicentre studies with defined reference standards for diagnosis, and studies evaluating therapeutic impact are needed.

Imaging of Proliferation in Hepatocellular Carcinoma with the In Vivo Marker 18F-Fluorothymidine

“…The sensitivity of MRI for the detection of HCC is slightly higher than that of CT, with values of between 75% and 94% (23). The diagnosis of HCC is considered to be very likely for tumors larger than 20 mm and in the presence of markedly increased serum a-fetoprotein levels (.400 mg/L) (23).…”

Management of hepatocellular carcinoma: Enlightening the gray zones

“…The diagnostic criteria of HCC has recently had a dramatic evolution during recent years [1][2][3][4]24] . In fact, till the first half of the past decade, the Golden Standard for HCC diagnosis was histology.…”

Surveillance and diagnosis of hepatocellular carcinoma in patients with cirrhosis

“…Whether MRI or CT should be the first imaging technique to characterise a nodule after ultrasound depends on the availability and characteristics of either technology in any one centre. Comparison of these is complicated by comparison of different generation machines [74] and different types of tumor. In general modern MRI appears more sensitive for the diagnosis of smaller nodules < 1.5 cm in a cirrhotic liver and in distinguishing regenerative/dysplastic nodules versus malignant ones.…”