The diagnostic and economic impact of contrast imaging techniques in the diagnosis of small hepatocellular carcinoma in cirrhosis
- Angelo Sangiovanni1,
- Matteo A Manini1,
- Massimo Iavarone1,
- Raffaella Romeo1,
- Laura V Forzenigo2,
- Mirella Fraquelli3,
- Sara Massironi3,
- Cristina Della Corte1,
- Guido Ronchi1,
- Maria Grazia Rumi1,
- Piero Biondetti2,
- Massimo Colombo1
- 1A.M. & A. Migliavacca Center for Liver Disease and 1st Division of Gastroenterology, Fondazione IRCCS Cà Granda Ospedale Maggiore Policlinico, University of Milan, Italy
- 2Division of Radiology, Fondazione IRCCS Cà Granda Ospedale Maggiore Policlinico, University of Milan, Italy
- 32nd Division of Gastroenterology Fondazione IRCCS Cà Granda Ospedale Maggiore Policlinico, University of Milan, Italy
- Correspondence to Dr Angelo Sangiovanni, 1st Division of Gastroenterology, Fondazione IRCCS Cà Granda Ospedale Maggiore Policlinico, Via F. Sforza 35, 20122 Milan, Italy;
- Revised 10 November 2009
- Accepted 12 November 2009
- Published Online First 1 December 2009
Background Contrast-enhanced ultrasound (CE-US), contrast CT scan and gadolinium dynamic MRI are recommended for the characterisation of liver nodules detected during surveillance of patients with cirrhosis with US.
Aim To assess the sensitivity, specificity, diagnostic accuracy and economic impact of all possible sequential combinations of contrast imaging techniques in patients with cirrhosis with 1–2 cm liver nodules undergoing US surveillance.
Patients/methods 64 patients with 67 de novo liver nodules (55 with a size of 1–2 cm) were consecutively examined by CE-US, CT, MRI, and a fine-needle biopsy (FNB) as diagnostic standard. Undiagnosed nodules were re-biopsied; non-malignant nodules underwent enhanced imaging follow-up. The typical radiological feature of hepatocellular carcinoma (HCC) was arterial phase hypervascularisation followed by portal/venous phase washout.
Results HCC was diagnosed in 44 (66%) nodules (2, <1 cm; 34, 1–2 cm; 8, >2 cm). The sensitivity of CE-US, CT and MRI for 1–2 cm HCC was 26, 44 and 44%, with 100% specificity, the typical vascular pattern of HCC being identified in 22 (65%) by a single technique versus 12 (35%) by at least two techniques carried out at the same time point (p=0.028). Compared with the cheapest dual examination (CE-US+CT), the cheapest single technique of stepwise imaging diagnosis of HCC was equally expensive (€26 440 vs €28 667), but led to a 23% reduction of FNB procedures (p=0.031).
Conclusions In patients with cirrhosis with a 1–2 cm nodule detected during surveillance, a single imaging technique showing a typical contrast pattern confidently permits the diagnosis of HCC, thereby reducing the need for FNB examinations.
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Funding The present study was supported by grant no. PUR 2008, University of Milan, and by a generous contribution from Dr Aldo Antognozzi.
Competing interests None.
Ethics approval This study was conducted with the approval of the Fondazione IRCCS Cà Granda Ospedale Maggiore Policlinico Milan.
Provenance and peer review Not commissioned; externally peer reviewed.