Brief Article
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World J Gastroenterol. Sep 7, 2010; 16(33): 4187-4192
Published online Sep 7, 2010. doi: 10.3748/wjg.v16.i33.4187
Diagnostic sensitivity of imaging modalities for hepatocellular carcinoma smaller than 2 cm
Keiji Mita, Soo Ryang Kim, Masatoshi Kudo, Susumu Imoto, Taisuke Nakajima, Kenji Ando, Katsumi Fukuda, Toshiyuki Matsuoka, Yoko Maekawa, Yoshitake Hayashi
Keiji Mita, Soo Ryang Kim, Susumu Imoto, Taisuke Nakajima, Kenji Ando, Katsumi Fukuda, Department of Gastroenterology, Kobe Asahi Hospital, Kobe 653-0801, Japan
Masatoshi Kudo, Department of Gastroenterology and Hepatology, Kinki University School of Medicine, Osakasayama 589-8511, Japan
Toshiyuki Matsuoka, Department of Radiology, Osaka City University Medical School, Osaka 558-8585, Japan
Yoko Maekawa, Department of Surgery, Hyogo Cancer Center, Akashi 673-8558, Japan
Yoshitake Hayashi, Center for Infectious Diseases, Kobe University Graduate School of Medicine, Kobe 650-0017, Japan
Author contributions: Mita K, Nakajima T and Ando K designed and performed the majority of imaging examinations; Maekawa Y and Fukuda K were involved in editing the manuscript; Imoto S provided the patient data; Kudo M and Matsuoka T carried out and reviewed the imaging studies; Kim SR and Hayashi Y made the pathological diagnosis of hepatocellular carcinoma; Kim SR wrote the paper.
Correspondence to: Dr. Soo Ryang Kim, Department of Gastroenterology, Kobe Asahi Hospital, 3-5-25 Bououji-cho, Nagata-ku, Kobe 653-0801, Japan. asahi-hp@arion.ocn.ne.jp
Telephone: +81-78-6125151 Fax: +81-78-6125152
Received: March 12, 2010
Revised: May 4, 2010
Accepted: May 11, 2010
Published online: September 7, 2010
Abstract

AIM: To compare the imaging results with histology and to evaluate the diagnostic sensitivity of imaging modalities for hepatocellular carcinoma (HCC) smaller than 2 cm.

METHODS: Nodules smaller than 2 cm (n = 34) revealed by ultrasonography (US) in 29 patients with liver cirrhosis were analyzed. Histological diagnosis of HCC was performed by ultrasonographic guidance: moderately-differentiated HCC (n = 24); well-differentiated HCC (n = 10). The patterns disclosed by the four imaging modalities defined the conclusive diagnosis of HCC: (1) contrast-enhanced computed tomography (CECT), hypervascularity in the arterial phase and washout in the equilibrium phase; (2) Sonazoid contrast-enhanced US (CEUS), hypervascularity in the early vascular phase and defect in the Kupffer phase; (3) gadolinium-ethoxybenzyl-diethylenetriamine pentaacetic acid (Gd-EOB-DTPA)-enhanced magnetic resonance imaging (MRI), hypervascularity in the arterial phase and/or defect in the hepatobiliary phase; and (4) CT arterioportal angiography: hypervascularity by CT during arteriography and/or perfusion defect by CT during arterial portography.

RESULTS: Overall, the sensitivity of diagnosing HCC smaller than 2 cm was 52.9% (18/34) (95% CI: 35.1-70.2) by CECT; 67.6% (23/34) (95% CI: 49.5-82.6) by Sonazoid CEUS; 76.5% (26/34) (95% CI: 58.8-89.3) by Gd-EOB-DTPA MRI; and 88.2% (30/34) (95% CI: 72.5-96.7) by CT arterioportal angiography. The diagnostic sensitivity of detecting moderately-differentiated HCC by CECT, Sonazoid CEUS, Gd-EOB-DTPA MRI and CT arterioportal angiography was 62.5% (15/24) (95% CI: 40.6-81.2), 79.2% (19/24) (95% CI: 57.8-92.9), 75.0% (18/24) (95% CI: 53.3-90.2) and 95.8% (23/24) (95% CI: 78.9-99.9), respectively. A significant difference (P < 0.05) was observed between CECT and CT arterioportal angiography in all nodules. There was no difference between Sonazoid CEUS, Gd-EOB-DTPA MRI, and CT arterioportal angiography. The combined sensitivity of Sonazoid CEUS and Gd-EOB-DTPA MRI was 94.1% (32/34).

CONCLUSION: Changing the main diagnostic modality for HCC smaller than 2 cm from CT arterioportal angiography to Sonazoid CEUS and Gd-EOB-DTPA MRI is recommended.

Keywords: Computed tomography arterioportal angiography; Contrast-enhanced computed tomography; Diagnostic sensitivity; Gd-EOB-DTPA-enhanced magnetic resonance imaging; Hepatocellular carcinoma smaller than 2 cm: Sonazoid contrast-enhanced ultrasonography