EASL and AASLD recommendations for the diagnosis of HCC to the test of daily practice

被引：105

作者：

Aube, Christophe ^{[1
,2
]}

Oberti, Frederic ^{[2
,3
]}

Lonjon, Julie ^{[4
]}

Pageaux, Georges ^{[5
]}

Seror, Olivier ^{[6
,7
,8
]}

N'Kontchou, Gisele ^{[9
]}

Rode, Agnes ^{[10
]}

Radenne, Sylvie ^{[11
]}

Cassinotto, Christophe ^{[12
]}

Vergniol, Julien ^{[13
]}

Bricault, Ivan ^{[14
,15
]}

Leroy, Vincent ^{[16
]}

Ronot, Maxime ^{[17
]}

Castera, Laurent ^{[18
,19
]}

Michalak, Sophie ^{[20
]}

Esvan, Maxime ^{[21
,22
]}

Vilgrain, Valerie ^{[19
,23
]}

机构：

[1] Univ Bretagne Loire, CHU Angers, Dept Radiol, Angers, France

[2] Univ Angers, Univ Bretagne Loire, Lab HIFIH, Angers, France

[3] Univ Bretagne Loire, CHU Angers, Serv Gastroenterol & Hepatol, Angers, France

[4] Univ Montpellier, CHU St Eloi, Dept Radiol, Montpellier, France

[5] Univ Montpellier, CHU St Eloi, Dept Hepatogastroenterol, Montpellier, France

[6] Hop Univ Paris Seine St Denis, AP HP, Hop Jean Verdier, Serv Radiol, Bondy, France

[7] Inst Natl Sante & Rech Med, Genom Fonct Tumeurs Solides, Unite Mixte Rech 1162, Paris, France

[8] Univ Paris 13, Communaute Univ & Etablissements Sorbonne Paris, Unite Format & Rech Sante Med & Biol Humaine, Paris, France

[9] Hop Univ Paris Seine St Denis, AP HP, Hop Jean Verdier, Serv Hepato Gastroenterol, Bondy, France

[10] CHU Lyon, Dept Radiol, Hop Croix Rousse, Lyon, France

[11] CHU Lyon, INSERM, Unite 1052, Serv Hepatol,Hop Croix Rousse, Lyon, France

[12] CHU Bordeaux, Hop Haut Leveque, Dept Imagerie Diagnost & Intervent, Pessac, France

[13] Hop Haut Leveque, CHU Bordeaux, Serv Hepatogastroenterol, Pessac, France

[14] CHU, Dept Imagerie Radiol & Imagerie Med, Grenoble, France

[15] Univ Grenoble Alpes, Lab Techn Biomed Engn & Complex Management Inform, Grenoble, France

[16] Univ Hosp, Serv Hepato Gastroenterol, Grenoble, France

[17] Hop Paris Nord Val de Seine, AP HP, Hop Beaujon, Dept Radiol, Clichy, France

[18] Hop Beaujon, AP HP, Serv Hepatol, Clichy, France

[19] Univ Paris Diderot, Sorbonne Paris Cite, CRI, U1149, Paris, France

[20] LUNAM Univ, CHU Angers, Dept Anatomopatol, Angers, France

[21] Hop Europeen Georges Pompidou, AP HP, Unite Epidemiol & Rech Clin, Paris, France

[22] INSERM, Ctr Invest Clin 1418, Module Epidemiol Clin, Paris, France

[23] Hop Paris Nord Val de Seine, AP HP, Hop Beaujon, Dept Radiol, Clichy, France

来源：

LIVER INTERNATIONAL | 2017年 / 37卷 / 10期

关键词：

Contrast-enhanced ultrasound; hepatocellular carcinoma; magnetic resonance imaging; multidetector computed tomography; SMALL HEPATOCELLULAR-CARCINOMA; CONTRAST-ENHANCED US; MULTIMODALITY APPROACH; AMERICAN ASSOCIATION; NODULES; LIVER; GUIDELINES; MANAGEMENT; PATTERN; IMPACT;

D O I：

10.1111/liv.13429

中图分类号：

R57 [消化系及腹部疾病];

学科分类号：

摘要：

AimsTo evaluate the diagnostic performance of CT, MRI and CEUS alone and in combination, for the diagnosis of HCC between 10 and 30mm, in a large population of cirrhotic patients. Patients and methodsIn a multicentre prospective trial, 442 patients have been enrolled. Within a month, CEUS, CT and MRI were performed for all patients. A composite algorithm was defined to obtain the more accurate gold standard. ResultsA total of 544 nodules in 381 patients have been retained for the performance analysis. Eighty-two percent of the patients were male, mean age was 62years. For the 10-20mm nodules (n=342), the sensitivity (Se) and specificity (Sp) for the diagnosis of HCC were, respectively, 70.6% and 83.2% for MRI, 67.9% and 76.8% for CT and 39.6% and 92.9% for CEUS. For the 20-30mm nodules (n=202), the Se and Sp were, respectively, 72.3% and 89.4% for MRI, 71.6% and 93.6% for CT and 52.9% and 91.5% for CEUS. The best combination for the 10-20mm nodules was MRI + CT (Se: 55.1%, Sp: 100.0%).After a first inconclusive technique, CEUS as second image technique allowed the highest specificity with only a slight drop of sensitivity for 10-20mm nodules and the highest sensitivity and specificity for 20-30mm nodules. ConclusionThis large multicentre study validates the EASL/AASLD recommendations in daily practice. Specificity using CT or MRI in 10-20mm HCC was low, but we do not recommend combined imaging at first as sensitivity would be very low. The best sequential approach combined MRI and CEUS.

引用

页码：1515 / 1525

页数：11

共 28 条

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