Ultrasonography and alpha-fetoprotein in diagnosis of hepatocellular carcinoma in cirrhosis.

The accuracy of ultrasound (US) and alpha-fetoprotein (AFP) in the diagnosis of hepatocellular carcinoma (HCC) in 363 patients with cirrhosis (C) and a clinical suspicion of HCC was assessed. The ultrasonographic patterns of HCC and their relationship with AFP values were analyzed. Echographic patterns were distributed as follows: 47 patients had sonodense lesions; 30 patients had hypoechoic lesions; 47 had mixed-pattern lesions, and in four patients focal dilated intrahepatic bile ducts were demonstrated. The sensitivity of US was 90%; specificity was 93.3%. Serum AFP level greater than or equal to 500 ng/ml (RIA) was the first clue to the diagnosis in 71 patients (48.6%); specificity was 100%. In 28 patients AFP levels became significantly elevated during follow-up after US detection of HCC. No relationship between echo pattern and serum AFP levels was demonstrated. An algorithm for diagnosis of HCC is proposed.

Sludge and stones in gallbladder after pregnancy. Prevalence and risk factors.

The prevalence of sludge and stones in the gallbladder of 298 women in the immediate post-partum period was ultrasonographically assessed. We have investigated some risk factors for the development of sludge or stones in these patients and followed up most of these patients by ultrasonography to detect the presence of sludge and/or stones in the year following their discovery. We found sludge in 80 (26.2%) and gallstones in 16 (5.2%) of these patients. Age, obesity and months of oral contraceptive use were risk factors only for the presence of gallstones. After 1 year of follow-up only 2 out of 45 patients with sludge but 13 out of 15 patients with gallstones still had abnormal ultrasonographic findings.

Predictive value of ultrasonography in the screening of non-ascitic cirrhotic patients with large varices.

To evaluate the accuracy of ultrasonography in the screening of cirrhotic patients with large varices, the receiver operator characteristic (ROC) curves of the portal, mesenteric, and splenic veins of 215 consecutive non-ascitic patients were plotted in order to select the most indicative optimal threshold. The contribution of respiratory variations of splenic and mesenteric veins was also evaluated. Taking 13 mm as the limit for the normal diameter of the portal vein, 10 and 9 mm for the upper limits of the mesenteric and splenic veins, respectively, and respiratory variations being absent, the positive rates were 91, 88, and 92 per cent and the false-positive rates were 44, 38, and 42 per cent, respectively. The predictive values of a positive test were 0.34, 0.33, and 0.34, respectively, and the predictive values of a negative test were 0.96 for the portal and mesenteric veins and 0.97 for the splenic vein. Because the portal vein is always visible, the portal diameter may be employed in the screening through the presence of large varices in association with the assessment of respiratory variation in the splenic or mesenteric diameter. A cut-off point of 13 mm and the absence of respiratory variations precludes the need for endoscopy in 47 per cent of patients.

Ultrasonographic and radionuclide detection of hepatocellular carcinoma in cirrhotics with low alpha-fetoprotein levels.

A total of 67 cirrhotic patients with clinically suspected neoplastic degeneration and low alpha-fetoprotein levels were assessed prospectively with ultrasound and gold (198Au) scintigraphy. Ultrasound showed space-occupying lesions in 22 of the 24 patients who had a final diagnosis of hepatocellular carcinoma (HCC) (sensitivity, 95.8%) and excluded the presence of HCC in 37 of the 43 patients with cirrhosis only (specificity, 86.0%; efficiency, 90.8%). Scintigraphy demonstrated a cold defect in 22 of the 24 patients who had a final diagnosis of HCC (sensitivity, 95.8%) and excluded the presence of HCC in 22 of the 43 patients with cirrhosis only (specificity, 51.1%; efficiency, 69.8%). It was concluded that the most accurate screening plain in cirrhotic patients suspected of having HCC with alpha-fetoprotein values below 500 ng/ml would consist of ultrasonography followed, as clinically indicated, by ultrasonographic or laparoscopic guided biopsy.

[Echography in patients with clinically suspected pancreatic carcinoma. Analysis of a prospective study]. / L'ecografia nei pazienti con sospetto clinico di carcinoma pancreatico. Analisi di uno studio prospettico.

Cancer of the pancreas is the fourth cause of death for tumor in USA; ultrasound has been shown a sensitive and specific technique in detection of this condition. We have prospectively studied with ultrasound 76 patients with clinical suspicion of cancer of the pancreas. Forty of these patients had carcinoma of the pancreas (histologically proved) and in the other 36 patients the cancer was clinically and/or surgically excluded. Sensitivity of ultrasound was 100%; specificity was 73%. The great part of our false-positive results were patients in which ultrasound detected a modification in the head of the pancreas and in which we couldn't have a biopsy from surgeons. The role of ultrasound scanning as first procedure to use in patients with clinical suspicion of carcinoma of the pancreas is confermed.

Ultrasound in the diagnosis of hepatocellular carcinoma associated with cirrhosis.

A total of 100 cirrhotic patients with clinically suspected neoplastic transformation was assessed prospectively with ultrasound. Ultrasound was diagnostic in 27/30 patients who had a final diagnosis of hepatocellular carcinoma (sensitivity 90%); there were five false-positive examinations (specificity 93%). The positive predictive value of the test was 84.4%; negative predictive value was 95%. Three different ultrasound patterns were observed in hepatocellular carcinoma: increased reflectivity, decreased reflectivity, and mixed echo pattern. Ultrasound can be used as a safe, effective first-line screening test for cirrhotic patients with clinically suspected neoplastic transformation.