Differentiation Of Small Hepatocellular Carcinoma Research Articles

Differentiation of Small Hepatocellular Carcinoma From Dysplastic Nodules in Cirrhotic Liver: Texture Analysis Based on MRI Improved Performance in Comparison Over Gadoxetic Acid-Enhanced MR and Diffusion-Weighted Imaging.

Background: Accurate characterization of small (3 cm) hepatocellular carcinoma (sHCC) and dysplastic nodules (DNs) in cirrhotic liver is challenging. We aimed to investigate whether texture analysis (TA) based on T2-weighted images (T2WI) is superior to qualitative diagnosis using gadoxetic acid-enhanced MR imaging (Gd-EOB-MRI) and diffusion-weighted imaging (DWI) for distinguishing sHCC from DNs in cirrhosis.Materials and methods: Sixty-eight patients with 73 liver nodules (46 HCCs, 27 DNs) pathologically confirmed by operation were included. For imaging diagnosis, three sets of images were reviewed by two experienced radiologists in consensus: a Gd-EOB-MRI set, a DWI set, and a combined set (combination of Gd-EOB-MRI and DWI). For TA, 279 texture features resulting from T2WI were extracted for each lesion. The performance of each approach was evaluated by a receiver operating characteristic analysis. The area under the receiver operating characteristic curve (Az), sensitivity, specificity, and accuracy were determined.Results: The performance of TA (Az = 0.96) was significantly higher than that of imaging diagnosis using Gd-EOB-MRI set (Az = 0.86) or DWI set (Az = 0.80) alone in differentiation of sHCC from DNs (P = 0.008 and 0.025, respectively). The combination of Gd-EOB-MRI and DWI showed a greater sensitivity (95.6%) but reduced specificity (66.7%). The specificity of TA (92.6%) was significantly higher than that of the combined set (P < 0.001), but no significant difference was observed in sensitivity (97.8 vs. 95.6%, P = 0.559).Conclusion: TA-based T2WI showed a better classification performance than that of qualitative diagnosis using Gd-EOB-MRI and DW imaging in differentiation of sHCCs from DNs in cirrhotic liver. TA-based MRI may become a potential imaging biomarker for the early differentiation HCCs from DNs in cirrhosis.

Role of serum glypican-3 in the diagnosis and differentiation of small hepatocellular carcinoma from hepatitis-C virus cirrhosis

BackgroundSerum alpha-fetoprotein (AFP) has insufficient sensitivity and specificity for detection of hepatocellular carcinoma (HCC). Recently, glypican-3 (GLP-3) was suggested as a new biomarker for the detection HCC. ObjectivesTo determine the role of serum GLP-3 levels in the early diagnosis and differentiation of small (3cm or less in diameter) HCC from liver cirrhosis. Also, to correlate GLP-3 levels to clinico-laboratory data. MethodsThe study included sixty patients; 30 of them with hepatitis C virus (HCV) cirrhosis, and 30 patients with proved HCC. In addition, 20 healthy subjects were included as a control group. Clinical and radiological features (abdominal ultrasonography and/or abdominal triphasic computed tomography) were recorded. Liver function tests, complete blood cell count, and serum AFP were measured. Serum GLP-3 values were determined by an ELISA technique. ResultsSerum levels of GLP-3 were significantly elevated in patients with HCC compared with HCV cirrhosis group (p<0.001). Also, these levels were significantly elevated in these two patients’ groups versus controls (p<0.001). Also, serum GLP-3 levels with cut-off value of ⩾240ug/L, had a higher sensitivity (100%) and same specificity (93.3%), than AFP with cut-off value of ⩾200ng/ml, for detection of HCC. Moreover, GLP-3 levels showed a higher sensitivity than AFP (50% vs.41.7%), for detection of small HCC. The combined use of both markers (i.e. when either one of the two markers positive) improved the specificity to 88.9%. Regarding unicentric HCC, GLP-3 at cut-off value of ⩽580ug/L had better specificity than AFP at cut-off value of ⩽765ng/ml (57.1% vs. 42.9%). The combined use of both markers improved the sensitivity and specificity to 82.6% and 71.4%, respectively. ConclusionSerum GLP-3 levels are higher in HCC versus HCV cirrhosis, which can differentiate HCC from liver cirrhosis. Also, serum GLP-3 is highly sensitive and specific for detecting HCC. Moreover, GLP-3 is more sensitive than AFP for the detection of small HCC. Furthermore, a combination of both serum markers yielded an improved specificity and both sensitivity and specificity for the diagnosis of small and unicentric HCC, respectively.

Improved diagnosing of small hepatocellular carcinomas by echo-enhanced power Doppler sonography in patients with cirrhosis.

Echo-enhanced power Doppler sonography is an increasingly used procedure for the differentiation of liver tumours. The aim of this prospective study was to investigate the accuracy of echo-enhanced power Doppler sonography in comparison with conventional ultrasound and fundamental power Doppler sonography in diagnosing hepatocellular carcinomas and regenerative nodules in patients with cirrhosis. Eighty-seven patients with cirrhosis and 90 liver tumours at conventional ultrasound were included in the study, selected from 103 consecutive patients with a mean age of 60 years (range 23-87 years) who presented to our department from January 1998 through January 2002. Sonography was performed by an experienced examiner, who was unaware of the clinical diagnosis. The exact diagnosis was based upon histological evidence from biopsy examination, laboratory results, and/or a follow-up of at least 18 months. There were 65 hepatocellular carcinomas, 21 regenerative nodules, and four metastases in the study group. Only 43% of the carcinomas (mainly nodules > 3 cm in diameter) could be classified correctly by conventional ultrasound or fundamental power Doppler sonography. However, 46% of the malign lesions (mainly nodules < 3 cm in diameter) were not differentiable. All non-differentiable tumours were classified correctly by echo-enhanced power Doppler sonography. The overall sensitivity of echo-enhanced power Doppler sonography with respect to diagnosing hepatocellular carcinoma was 89%; its specificity was 60%. The corresponding values for regenerative nodules were 71% and 100%, respectively. Only hepatocellular carcinomas greater than 3 cm in size can be diagnosed with a high accuracy by conventional ultrasound or fundamental power Doppler sonography. However, small malignant lesions in cirrhotic livers are often not differentiable with these techniques. With echo-enhanced power Doppler sonography, the differentiation of small hepatocellular carcinomas can be improved. However, histology is the standard of reference.

Focal Hepatic Nodules with High Signal Intensity on T1-weighted MR Imaging: Differentiation of Small Hepatocellular Carcinoma from Dysplastic Nodule by Quantitative Analysis of Multi-phase Contrast-enhanced DynamicMR Imaging

Purpose : To evaluate the usefulness of quantitative analysis of the degree of enhancement in dynamic MRimaging used to differentiate dysplastic nodule (DN) from small hepatocellular carcinoma (HCC), both of which showhigh signal intensity on T1-weighted images. Materials and Methods : From 26 small HCCs and 71 DNs, all of whichshowed homogeneous high signal in-tensity on T1-weighted images among 42 patients with liver cirrhosis, weselected 16 small HCCs and 10 DNs of more than 1cm in diameter which were diagnosed by biopsy and follow-upimaging. Dynamic MR imaging of the entire liver was obtained using the breath-hold technique at postinjection 10sec. (phase 1), 35 sec. (phase 2), 60 sec. (phase 3), and 5 min. (delayed) after intravenous manual injection ofGd-DTPA (0.1 mmol/kg) at a velocity of 3-4 cc/sec. Nodule-to-liver contrast-to-noise ratios (CNR) during eachphase were calculated by measurement of the region of interest. Results : On precontrast T1-weighted images, themean CNR of small HCCs was 2.873, and that of DNs was 3.854, there was thus no significant statistical difference(p>0.01). On postcontrast images, the CNR of small HCCs during each phase was 5.565, 3.790, 1.704, and 1.282, withpeak CNR phase 1 and a mostly decreasing trend thereafter. However, the CNR of DNs during each phase was 3.053,1.561, 0.919, and 1.038 ; there was thus showed no significant increase during phase 1 in comparison with the CNRsseen on precontrast images. During the precontrast stage and phase 1, the average difference in CNR was 2.691 forsmall HCCs and 0.801 for DNs the difference was thus significant (p