Skip to main content
Erschienen in: European Radiology 3/2009

01.03.2009 | Hepatobiliary-Pancreas

The added diagnostic value of 64-row multidetector CT combined with contrast-enhanced US in the evaluation of hepatocellular nodule vascularity: implications in the diagnosis of malignancy in patients with liver cirrhosis

verfasst von: Emilio Quaia, Valerio Alaimo, Elisa Baratella, Alessandro Medeot, Massimo Midiri, Maria Assunta Cova

Erschienen in: European Radiology | Ausgabe 3/2009

Einloggen, um Zugang zu erhalten

Abstract

The aim of this study was to assess the added diagnostic value of contrast-enhanced US (CEUS) combined with 64-row multidetector CT (CT) in the assessment of hepatocellular nodule vascularity in patients with liver cirrhosis. One hundred and six cirrhotic patients (68 male, 38 female; mean age ± SD, 70 ± 7 years) with 121 biopsy-proven hepatocellular nodules (72 hepatocellular carcinomas, 10 dysplastic and 15 regenerative nodules, 12 hemangiomas, and 12 other benignancies) detected during US surveillance were prospectively recruited. Each nodule was scanned by CEUS during the arterial (10–40 s), portal venous (45–90 s), and delayed sinusoidal phase (from 100 s after microbubble injection to microbubble disappearance). Nodule vascularity at CEUS, CT, and combined CEUS/CT was evaluated side-by-side by two independent blinded readers who classified nodules as benign or malignant according to reference diagnostic criteria. The combined assessment of CEUS/CT provided higher sensitivity (97%, both readers) than did separate assessment of CEUS (88% reader 1; 87% reader 2) and CT (74% reader 1; 71% reader 2; P < 0.05), while no change in specificity was provided by combined analysis. The combined assessment of hepatocellular nodule vascularity at CT and CEUS improved sensitivity in the diagnosis of malignancy in patients with liver cirrhosis.
Literatur
1.
Zurück zum Zitat International Working Party (1995) Terminology of nodular hepatocellular lesions. Hepatology 22:983–993 International Working Party (1995) Terminology of nodular hepatocellular lesions. Hepatology 22:983–993
2.
Zurück zum Zitat Bruix J, Sherman M, Llovet JM et al (2001) Clinical management of hepatocellular carcinoma. Conclusions of the Barcelona-2000 EASL conference. European Association for the Study of the Liver. J Hepatol 35:421–430CrossRefPubMed Bruix J, Sherman M, Llovet JM et al (2001) Clinical management of hepatocellular carcinoma. Conclusions of the Barcelona-2000 EASL conference. European Association for the Study of the Liver. J Hepatol 35:421–430CrossRefPubMed
3.
4.
Zurück zum Zitat Iannacone R, Laghi A, Catalano C et al (2004) Focal liver lesions in the cirrhotic patient: multislice spiral CT evaluation. Radiol Med 107:304–316 Iannacone R, Laghi A, Catalano C et al (2004) Focal liver lesions in the cirrhotic patient: multislice spiral CT evaluation. Radiol Med 107:304–316
5.
Zurück zum Zitat Laghi A, Iannacone R, Rossi P et al (2003) Hepatocellular carcinoma: detection with triple-phase multi-detector row helical CT in patients with chronic hepatitis. Radiology 226:543–549CrossRefPubMed Laghi A, Iannacone R, Rossi P et al (2003) Hepatocellular carcinoma: detection with triple-phase multi-detector row helical CT in patients with chronic hepatitis. Radiology 226:543–549CrossRefPubMed
6.
Zurück zum Zitat Ichikawa T, Kakajima H, Nanbu A, Hori M, Araki T (2006) Effect of injection rate of contrast material on CT of hepatocellular carcinoma. AJR Am J Roentgenol 186:1413–1418CrossRefPubMed Ichikawa T, Kakajima H, Nanbu A, Hori M, Araki T (2006) Effect of injection rate of contrast material on CT of hepatocellular carcinoma. AJR Am J Roentgenol 186:1413–1418CrossRefPubMed
7.
Zurück zum Zitat Monzawa S, Ichikawa T, Nakajima H, Kitanaka Y, Omata K, Araki T (2007) Dynamic CT for detecting small hepatocellular carcinoma: usefulness of delayed phase imaging. AJR Am J Roentgenol 188:147–153CrossRefPubMed Monzawa S, Ichikawa T, Nakajima H, Kitanaka Y, Omata K, Araki T (2007) Dynamic CT for detecting small hepatocellular carcinoma: usefulness of delayed phase imaging. AJR Am J Roentgenol 188:147–153CrossRefPubMed
8.
Zurück zum Zitat Claudon M, Cosgrove D, Albrecht T et al (2008) Guidelines and good clinical practice recommendations for contrast enhanced ultrasound (CEUS)–Update 2008. Ultraschall Med 29:28–44CrossRefPubMed Claudon M, Cosgrove D, Albrecht T et al (2008) Guidelines and good clinical practice recommendations for contrast enhanced ultrasound (CEUS)–Update 2008. Ultraschall Med 29:28–44CrossRefPubMed
9.
Zurück zum Zitat Quaia E, Calliada F, Bertolotto M, Rossi S, Garioni L, Rosa L, Pozzi-Mucelli R (2004) Characterization of focal liver lesions by contrast-specific US modes and a sulfur hexafluoride-filled microbubble contrast agent: diagnostic performance and confidence. Radiology 232:420–430CrossRefPubMed Quaia E, Calliada F, Bertolotto M, Rossi S, Garioni L, Rosa L, Pozzi-Mucelli R (2004) Characterization of focal liver lesions by contrast-specific US modes and a sulfur hexafluoride-filled microbubble contrast agent: diagnostic performance and confidence. Radiology 232:420–430CrossRefPubMed
10.
Zurück zum Zitat Nicolau C, Catalá V, Vilana R, Gilabert R, Bianchi L, Sole M, Pages M, Bru C (2004) Evaluation of hepatocellular carcinoma using SonoVue, a second generation ultrasound contrast agent: correlation with cellular differentiation. Eur Radiol 14:1092–1099CrossRefPubMed Nicolau C, Catalá V, Vilana R, Gilabert R, Bianchi L, Sole M, Pages M, Bru C (2004) Evaluation of hepatocellular carcinoma using SonoVue, a second generation ultrasound contrast agent: correlation with cellular differentiation. Eur Radiol 14:1092–1099CrossRefPubMed
11.
Zurück zum Zitat Giorgio A, Ferraioli G, Tarantino L et al (2004) Contrast-enhanced sonographic appearance of hepatocellular carcinoma in patients with cirrhosis: Comparison with contrast-enhanced CT appearance. AJR Am J Roentgenol 183:1319–1326PubMed Giorgio A, Ferraioli G, Tarantino L et al (2004) Contrast-enhanced sonographic appearance of hepatocellular carcinoma in patients with cirrhosis: Comparison with contrast-enhanced CT appearance. AJR Am J Roentgenol 183:1319–1326PubMed
12.
Zurück zum Zitat Quaia E, D’Onofrio M, Cabassa P et al (2007) Diagnostic value of hepatocellular nodule vascularity after sulfur hexafluoride-filled microbubble injection in patients with liver cirrhosis: analysis of diagnostic performance and confidence in malignancy characterization. AJR Am J Roentgenology 189:1474–1483CrossRef Quaia E, D’Onofrio M, Cabassa P et al (2007) Diagnostic value of hepatocellular nodule vascularity after sulfur hexafluoride-filled microbubble injection in patients with liver cirrhosis: analysis of diagnostic performance and confidence in malignancy characterization. AJR Am J Roentgenology 189:1474–1483CrossRef
13.
Zurück zum Zitat Gaiani S, Celli N, Piscaglia F et al (2004) Usefulness of contrast-enhanced perfusional sonography in the assessment of hepatocellular carcinoma hypervascular at spiral computed tomography. J Hepatol 41:421–426CrossRefPubMed Gaiani S, Celli N, Piscaglia F et al (2004) Usefulness of contrast-enhanced perfusional sonography in the assessment of hepatocellular carcinoma hypervascular at spiral computed tomography. J Hepatol 41:421–426CrossRefPubMed
14.
Zurück zum Zitat Bolondi L, Gaiani S, Celli N et al (2005) Characterization of hepatocellular nodules in 40 cirrhosis by assessment of vascularity: the problem of hypovascular hepatocellular carcinoma. Hepatology 42:27–34CrossRefPubMed Bolondi L, Gaiani S, Celli N et al (2005) Characterization of hepatocellular nodules in 40 cirrhosis by assessment of vascularity: the problem of hypovascular hepatocellular carcinoma. Hepatology 42:27–34CrossRefPubMed
15.
Zurück zum Zitat Pompili M, Riccardi L, Semeraro S et al (2008) Contrast-enhanced ultrasound assessment of arterial vascularization of small nodules arising in the cirrhotic liver. Dig Liver Dis 40(3):206–215CrossRefPubMed Pompili M, Riccardi L, Semeraro S et al (2008) Contrast-enhanced ultrasound assessment of arterial vascularization of small nodules arising in the cirrhotic liver. Dig Liver Dis 40(3):206–215CrossRefPubMed
16.
Zurück zum Zitat Burns P, Wilson SR (2007) Focal liver lesions: enhancement patterns on contrast-enhanced images – Concordance of US scans with CT scans and MR images. Radiology 242(1):162–174CrossRefPubMed Burns P, Wilson SR (2007) Focal liver lesions: enhancement patterns on contrast-enhanced images – Concordance of US scans with CT scans and MR images. Radiology 242(1):162–174CrossRefPubMed
17.
Zurück zum Zitat Forner A, Villana R, Ayuso C et al (2008) Diagnosis of hepatic nodules 20 mm or smaller in cirrhosis: prospective validation of the noninvasive diagnostic criteria for hepatocellular carcinoma. Hepatology 47:97–104CrossRefPubMed Forner A, Villana R, Ayuso C et al (2008) Diagnosis of hepatic nodules 20 mm or smaller in cirrhosis: prospective validation of the noninvasive diagnostic criteria for hepatocellular carcinoma. Hepatology 47:97–104CrossRefPubMed
18.
19.
Zurück zum Zitat Couinaud C (1957) Le foie: études anatomiques et chirurgicales. Masson, Paris, pp 9–12 Couinaud C (1957) Le foie: études anatomiques et chirurgicales. Masson, Paris, pp 9–12
20.
Zurück zum Zitat Sultana S, Awai K, Nakayama Y et al (2007) Hypervascular hepatocellular carcinomas: bolus tracking with a 40-detector CT scanner to time arterial phase imaging. Radiology 243:140–147CrossRefPubMed Sultana S, Awai K, Nakayama Y et al (2007) Hypervascular hepatocellular carcinomas: bolus tracking with a 40-detector CT scanner to time arterial phase imaging. Radiology 243:140–147CrossRefPubMed
21.
Zurück zum Zitat Beck JR, Shultz EK (1986) The use of relative operating characteristic (ROC) curves in test performance evaluation. Arch Pathol Lab Med 110:13–20PubMed Beck JR, Shultz EK (1986) The use of relative operating characteristic (ROC) curves in test performance evaluation. Arch Pathol Lab Med 110:13–20PubMed
22.
Zurück zum Zitat Hanley JA, McNeil BJ (1983) A method of comparing the areas under receiver operating characteristic curves derived from the same cases. Radiology 148:839–843PubMed Hanley JA, McNeil BJ (1983) A method of comparing the areas under receiver operating characteristic curves derived from the same cases. Radiology 148:839–843PubMed
23.
Zurück zum Zitat Tanaka S, Ioka T, Oshikawa O, Hamada Y, Yoshioka F (2001) Dynamic sonography of hepatic tumours. AJR Am J Roentgenol 177:799–805PubMed Tanaka S, Ioka T, Oshikawa O, Hamada Y, Yoshioka F (2001) Dynamic sonography of hepatic tumours. AJR Am J Roentgenol 177:799–805PubMed
24.
Zurück zum Zitat Lee HM, Lu DS, Krasny RM, Busuttil R, Kadell B, Lucas J (1997) Hepatic lesion characterization in cirrhosis: significance of arterial hypervascularity on dual-phase helical CT. AJR Am J Roentgenol 169:125–130PubMed Lee HM, Lu DS, Krasny RM, Busuttil R, Kadell B, Lucas J (1997) Hepatic lesion characterization in cirrhosis: significance of arterial hypervascularity on dual-phase helical CT. AJR Am J Roentgenol 169:125–130PubMed
25.
Zurück zum Zitat Baron RL, Peterson MS (2001) Screening the cirrhotic liver for hepatocellular carcinoma with CT and MR imaging: opportunities and pitfalls. Radiographics 21:S117–S132PubMed Baron RL, Peterson MS (2001) Screening the cirrhotic liver for hepatocellular carcinoma with CT and MR imaging: opportunities and pitfalls. Radiographics 21:S117–S132PubMed
26.
Zurück zum Zitat Lim JH, Kim CK, Lee WJ et al (2000) Detection of hepatocellular carcinomas and dysplastic nodules in cirrhotic livers: accuracy of helical CT in transplant patients. AJR Am J Roentgenol 175:693–698PubMed Lim JH, Kim CK, Lee WJ et al (2000) Detection of hepatocellular carcinomas and dysplastic nodules in cirrhotic livers: accuracy of helical CT in transplant patients. AJR Am J Roentgenol 175:693–698PubMed
27.
Zurück zum Zitat Rode A, Bancel B, Douek P et al (2001) Small nodule detection in cirrhotic livers: evaluation with US, spiral CT, and MRI and correlation with pathologic examination of explanted liver. J Comput Assist Tomogr 25(3):327–336CrossRefPubMed Rode A, Bancel B, Douek P et al (2001) Small nodule detection in cirrhotic livers: evaluation with US, spiral CT, and MRI and correlation with pathologic examination of explanted liver. J Comput Assist Tomogr 25(3):327–336CrossRefPubMed
28.
Zurück zum Zitat Valls C, Cos M, Figueras J et al (2004) Pretransplantation diagnosis and staging of hepatocellular carcinoma in patients with cirrhosis: value of dual phase helical CT. AJR Am J Roentgenol 182:1011–1017PubMed Valls C, Cos M, Figueras J et al (2004) Pretransplantation diagnosis and staging of hepatocellular carcinoma in patients with cirrhosis: value of dual phase helical CT. AJR Am J Roentgenol 182:1011–1017PubMed
29.
Zurück zum Zitat Forner A, Vilana R, Ayuso C et al (2007) Diagnosis of hepatic nodules 20 mm or smaller in cirrhosis: prospective validation of the noninvasive diagnostic criteria for hepatocellular carcinoma. Hepatology 47:1–7CrossRef Forner A, Vilana R, Ayuso C et al (2007) Diagnosis of hepatic nodules 20 mm or smaller in cirrhosis: prospective validation of the noninvasive diagnostic criteria for hepatocellular carcinoma. Hepatology 47:1–7CrossRef
30.
Zurück zum Zitat Krinsky GA, Lee VS, Theise ND et al (2001) Hepatocellular carcinoma and dysplastic nodules in patients with cirrhosis: prospective diagnosis with MR imaging and explantation correlation. Radiology 219:445–454PubMed Krinsky GA, Lee VS, Theise ND et al (2001) Hepatocellular carcinoma and dysplastic nodules in patients with cirrhosis: prospective diagnosis with MR imaging and explantation correlation. Radiology 219:445–454PubMed
31.
Zurück zum Zitat Bhartia B, Ward J, Guthrie JA, Robinson PJ (2003) Hepatocellular carcinoma in cirrhotic livers: double-contrast thin-section MR imaging with pathologic correlation of explanted tissue. AJR Am J Roentgenol 180:577–584PubMed Bhartia B, Ward J, Guthrie JA, Robinson PJ (2003) Hepatocellular carcinoma in cirrhotic livers: double-contrast thin-section MR imaging with pathologic correlation of explanted tissue. AJR Am J Roentgenol 180:577–584PubMed
Metadaten
Titel
The added diagnostic value of 64-row multidetector CT combined with contrast-enhanced US in the evaluation of hepatocellular nodule vascularity: implications in the diagnosis of malignancy in patients with liver cirrhosis
verfasst von
Emilio Quaia
Valerio Alaimo
Elisa Baratella
Alessandro Medeot
Massimo Midiri
Maria Assunta Cova
Publikationsdatum
01.03.2009
Verlag
Springer-Verlag
Erschienen in
European Radiology / Ausgabe 3/2009
Print ISSN: 0938-7994
Elektronische ISSN: 1432-1084
DOI
https://doi.org/10.1007/s00330-008-1179-3

Weitere Artikel der Ausgabe 3/2009

European Radiology 3/2009 Zur Ausgabe

Akuter Schwindel: Wann lohnt sich eine MRT?

28.04.2024 Schwindel Nachrichten

Akuter Schwindel stellt oft eine diagnostische Herausforderung dar. Wie nützlich dabei eine MRT ist, hat eine Studie aus Finnland untersucht. Immerhin einer von sechs Patienten wurde mit akutem ischämischem Schlaganfall diagnostiziert.

Screening-Mammografie offenbart erhöhtes Herz-Kreislauf-Risiko

26.04.2024 Mammografie Nachrichten

Routinemäßige Mammografien helfen, Brustkrebs frühzeitig zu erkennen. Anhand der Röntgenuntersuchung lassen sich aber auch kardiovaskuläre Risikopatientinnen identifizieren. Als zuverlässiger Anhaltspunkt gilt die Verkalkung der Brustarterien.

S3-Leitlinie zu Pankreaskrebs aktualisiert

23.04.2024 Pankreaskarzinom Nachrichten

Die Empfehlungen zur Therapie des Pankreaskarzinoms wurden um zwei Off-Label-Anwendungen erweitert. Und auch im Bereich der Früherkennung gibt es Aktualisierungen.

Fünf Dinge, die im Kindernotfall besser zu unterlassen sind

18.04.2024 Pädiatrische Notfallmedizin Nachrichten

Im Choosing-Wisely-Programm, das für die deutsche Initiative „Klug entscheiden“ Pate gestanden hat, sind erstmals Empfehlungen zum Umgang mit Notfällen von Kindern erschienen. Fünf Dinge gilt es demnach zu vermeiden.

Update Radiologie

Bestellen Sie unseren Fach-Newsletter und bleiben Sie gut informiert.