Abstract
e14606 Background: Contrast-enhanced ultrasound (CE-US), contrast computerized tomography (CT)-scan and gadolinium dynamic magnetic resonance (MRI), are recommended for the characterization of liver nodules detected during surveillance of cirrhotics with US. In a recent study of 64 patients with 67 liver nodules, a sensitivity of 26%, 44% and 44% for CE-US, CT, and MRI for 1-2 cm hepatocellular carcinoma (HCC), with 100% specificity were demonstrated. Aim: To correlate the vascular pattern on contrast-enhanced imaging techniques with cell differentiation (grade) of HCC. Methods: Seventy-five cirrhotic patients were consecutively examined by CE-US, CT, MRI and a fine-needle biopsy as diagnostic standard. The typical radiological feature of HCC was arterial phase hypervascularization followed by portal/venous phase wash-out. Histopathological diagnoses were made according to the Edmonson grading system. Results: HCC was diagnosed in 52 (66%) nodules (3 < 1 cm, 41 1-2 cm, 8 > 2 cm). Tumor grading was grade I in 14 (27%, median diameter 1.5 cm), grade II in 24 (46%, median diameter 1.5 cm), grade III in 14 (27%, median diameter 1.8 cm), grade IV in none. There was no relationship between tumor differentiation and etiology of liver disease (virus vs alcohol), nodule size and alfafetoprotein levels. At CT scan, the typical vascular pattern was present in 27/52 (52%) HCC: 3 (21%) grade I, 14 (58%) grade II, 10 (71%) grade III (p = 0.02). On CE-US, the typical vascular pattern was present in 17/52 (33%) HCC: 3 grade I (21% of all grade I), 8 grade II (33% of all grade II), 6 grade III (43% of all grade III) (p = 0.48). At MRI, the typical vascular pattern was present in 23/52 (52%) HCC: 3 (21%) grade I, 11 (50%) grade II, 9 (64%) grade III (p = 0.06). The AASLD criteria for radiological diagnosis of HCC were present in 2 grade I HCC (14%), 11 grade II HCC (46%) and 9 grade III HCC (64%) (p = 0.02). Conclusions: The diagnostic accuracy of the AASLD radiological criteria for HCC is low in grade I tumors but appreciably increases in grade II and III HCC. No significant financial relationships to disclose.
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