ABSTRACT
Objective@#To compare the diagnostic efficacies of contrast-enhanced ultrasonography (CEUS) and gadoxetic acid-enhanced magnetic resonance imaging (EOB-MRI) in the diagnosis of liver nodules ≤2.0 cm in patients with cirrhosis, and to explore the clinical values of combining the arterial phase of CEUS and hepatobiliary phase of EOB-MRI in the diagnosis of early hepatocellular carcinoma (HCC).@*Methods@#One hundred and thirteen nodules with diameters lower than 2.0 cm in 98 patients from February to December 2016 in Tianjin Third Central Hospital were included in this retrospective study. The enhancement patterns of nodules in CEUS and EOB-MRI were analyzed. The reference standard was pathological diagnosis or substantial lesion growth at a follow-up of at least 6 months. The efficiencies of CEUS and EOB-MRI in the diagnosis of liver lesions with a diameter lower than 2.0 cm were compared. A new diagnostic strategy, which combines the arterial phase of CEUS and hepatobiliary phase of EOB-MRI was presented to diagnose the early HCC in this study.@*Results@#The area under the ROC curve of CEUS and EOB-MRI were 0.858 and 0.814(P>0.05), the sensitivity were 79.1%, 81.4%, specificity were 92.6%, 81.5% and diagnostic accuracy were 82.3% and 81.4%, respectively. By combination of CEUS and EOB-MRI, the area under the ROC curve was 0.831, without difference from CEUS, EOB-MRI (0.831 vs 0.858, 0.814; all P>0.05); its sensitivity was 66.3%, specificity was 100% and diagnostic accuracy was 74.3%. The area under the ROC curve of the new diagnostic strategy, combining the arterial phase of CEUS and hepatobiliary phase of EOB-MRI was 0.934, which was larger than that of CEUS, EOB-MRI and the combination of CEUS and EOB-MRI(0.934 vs 0.858, 0.814, 0.831; all P<0.05). The sensitivity, specificity and diagnostic accuracy of new strategy were 94.2%, 92.6% and 93.8%, respectively.@*Conclusions@#The new diagnostic strategy based on the arterial phase of CEUS and hepatobiliary phase of EOB-MRI improves the sensitivity and accuracy in detecting small lesions, which can be used as a complementary diagnostic enhancement pattern for lesions with an atypical enhancement pattern in CEUS or EOB-MRI.
ABSTRACT
Objective To compare the diagnostic efficacies of contrast-enhanced ultrasonography (CEUS) and gadoxetic acid-enhanced magnetic resonance imaging (EOB-MRI) in the diagnosis of liver nodules ≤2.0 cm in patients with cirrhosis,and to explore the clinical values of combining the arterial phase of CEUS and hepatobiliary phase of EOB-MRI in the diagnosis of early hepatocellular carcinoma (HCC).Methods One hundred and thirteen nodules with diameters lower than 2.0 cm in 98 patients from February to December 2016 in Tianjin Third Central Hospital were included in this retrospective study.The enhancement patterns of nodules in CEUS and EOB-MRI were analyzed.The reference standard was pathological diagnosis or substantial lesion growth at a follow-up of at least 6 months.The efficiencies of CEUS and EOB-MRI in the diagnosis of liver lesions with a diameter lower than 2.0 cm were compared.A new diagnostic strategy,which combines the arterial phase of CEUS and hepatobiliary phase of EOB-MRI was presented to diagnose the early HCC in this study.Results The area under the ROC curve of CEUS and EOB-MRI were 0.858 and 0.814 (P ＞ 0.05),the sensitivity were 79.1％,81.4％,specificity were 92.6 ％,81.5 ％ and diagnostic accuracy were 82.3 ％ and 81.4 ％,respectively.By combination of CEUS and EOB-MRI,the area under the ROC curve was 0.831,without difference from CEUS,EOB-MRI (0.831 vs 0.858,0.814;all P ＞0.05);its sensitivity was 66.3 ％,specificity was 100％ and diagnostic accuracy was 74.3％.The area under the ROC curve of the new diagnostic strategy,combining the arterial phase of CEUS and hepatobiliary phase of EOB-MRI was 0.934,which was larger than that of CEUS,EOB-MRI and the combination of CEUS and EOB-MRI(0.934 vs 0.858,0.814,0.831;all P ＜0.05).The sensitivity,specificity and diagnostic accuracy of new strategy were 94.2％,92.6％ and 93.8％,respectively.Conclusions The new diagnostic strategy based on the arterial phase of CEUS and hepatobiliary phase of EOB-MRI improves the sensitivity and accuracy in detecting small lesions,which can be used as a complementary diagnostic enhancement pattern for lesions with an atypical enhancement pattern in CEUS or EOB-MRI.
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Objective To investigate the early diagnostic ability of conventional imaging methods in micro-hepatocellular carcinoma(M HCC) in order to improve the imaging diagnostic procedure for M HCC.Methods The data of 40 cases of M HCC(52 lesions)and 21 cases of regenerative nodules(35 lesions)confirmed by clinical results were collected continuously.All the patients were examined with ultrasonography (US),plain CT combined with multi-phase enhancement scans,and plain MRI combined with diffusion weighted imaging(DWI).To compare the diagnostic efficacy of three different imaging methods,the imaging data were analyzed retrospectively by χ2test and receiver operating characteristic curve(ROC).Results There was a significant difference in the M HCC detection rate between US and CT,and between US and MRI,respectively(P<0.05).There was no significant difference in the MHCC detection rate between CT and MRI(P>0.05).The sensitivity of US,CT and MRI in the detection of MHCC was 61.5%,80.8% and 92.3%,specificity was 88.6%,91.4% and 97.1%,positive predictive value was 88.9%,93.3% and 98.0%,and area under the ROC curve was 0.751, 0.861 and 0.947,respectively.Plain MRI combined with DWI had the highest diagnostic efficacy,among the three imaging methods. Conclusion US can be used as a primary screening method for M HCC in high risk population,and plain CT combined with multi-phase enhancement scans can be the first choice for early diagnosis of MHCC.For highly suspected the cases with positive AFP but negative findings on US and CT,plain MRI combined with DWI are recommended to rule out the possibility.
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Objective To investigate the diagnostic value of DSA for micro hepatocelluar carcinoma(MHCC)in patients with hepatic cirrhosis. Methods Three hundred and fourty cases of hepatic cirrhosis who were going to receive bone marrow stem cells transplantation via hepatic artery underwent hepatic arterial DSA. No definite evidence of hepatoma had been found during the former CT scan and ultrasound test in these patients. Multi-angle projection DSA was performed to display the characteristics of MHCC and super-selective TACE treatment was given in cases of the diagnosed MHCC. Results MHCC were found by DSA in 20 cases who were all of post-hepatitis B cirrhosis and with single-lesion of sized 0.4 - 1.0 cm. DSA showed the characteristics of nodular stains in early or middle arterial phase in angiography. 18 lesions were in the right lobe and 2 in the left lobe. AFP were negative in 16 cases and positive in 4 cases. Super-selective segmental TACE were performed with micro catheter system for the treatment. Conclusions DSA is more sensitive to detect MHCC in the patients with hepatic cirrhosis, comparing with regular contrasted CT scan or ultrasound.