TY - JOUR
T1 - MRI angiography is superior to helical CT for detection of HCC prior to liver transplantation
T2 - An explant correlation
AU - Burrel, Marta
AU - Llovet, Josep M.
AU - Ayuso, Carmen
AU - Iglesias, Carmela
AU - Sala, Margarita
AU - Miquel, Rosa
AU - Caralt, Teresa
AU - Ayuso, Juan Ramon
AU - Solé, Manel
AU - Sanchez, Marcelo
AU - Brú, Concepció
AU - Bruix, Jordi
N1 - Funding Information:
Abbreviations: HCC, hepatocellular carcinoma; LT, liver transplantation; US, ultrasonography; CT, computerized tomography; MRI, magnetic resonance imaging; RES, reticuloendothelial system; SPIO, super paramagnetic iron oxide; MRA, magnetic resonance imaging angiography; LDLT, living donor liver transplantation; HGDN, high-grade dysplastic nodule; MRN macroregenerative nodule; ROC, receiver operating characteristic. From the 1Radiology Department, 2Liver Unit, and 3Pathology Department, Institut d’Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Hospital Clínic, University of Barcelona, Catalonia, Spain. Received June 17, 2003; accepted July 18, 2003. Supported by a contract from Programa “Ramon y Cajal” (IDIBAPS, Ministerio de Ciencia y Tecnología; to J.M.L.) and supported in part by a grant of Instituto de Salud Carlos III (C03/02). Address reprint requests to: Jordi Bruix, M.D., BCLC Group, Liver Unit IMD, Hospital Clínic i Provincial Villarroel 170, 08036-Barcelona, Catalonia, Spain. E-mail: [email protected]; fax: (34) 93-227-9803. Copyright © 2003 by the American Association for the Study of Liver Diseases. 0270-9139/03/3804-0029$30.00/0 doi:10.1053/jhep.2003.50409
PY - 2003/10/1
Y1 - 2003/10/1
N2 - Helical computerized tomography (CT) and magnetic resonance imaging (MRI) are used for staging of hepatocellular carcinoma (HCC) prior to curative treatments but underestimate tumor extension in 30% to 50% of cases when compared with pathologic explants. This study compares a new technology, MRI angiography (MRA), with triphasic helical CT in detection of HCC. Fifty cirrhotic patients, 29 with HCC, undergoing liver transplantation were analyzed. MRA was performed with a 3-D breath-hold fast spoiled gradient-echo sequence by using an effective section thickness of 2 to 2.5 mm. The gold standard was the pathologic examination (liver cut into 5-mm slices). One hundred twenty-seven lesions were identified at the explant: 76 HCC, 13 high-grade dysplastic nodules, 31 macroregenerative nodules, 7 hemangiomas. Diameter of the main HCC nodules was 29 ± 14 mm and 11 ± 7 mm for the 47 additional nodules. On a per nodule basis, sensitivity of MRA was superior to CT (58/76 [76%] vs. 43/70 [61%], respectively, P = .001). Sensitivity of MRA for detection of additional nodules decreased with size (> 20 mm: 6/6 [100%] ; 10-20 mm: 16/19 [84%]; < 10 mm: 7/22 [32%]) and was superior to CT for nodules 10 to 20 mm (84% vs. 47%, P = .016). Nonspecific hypervascular nodules > 5 mm at MRA were HCC in two thirds of the cases. In conclusion, MRA has a high diagnostic accuracy for HCC ≥10 mm and is more sensitive than triphasic helical CT in nodules sized 10 to 20 mm. MRA is the optimal technique for HCC staging prior to curative therapies.
AB - Helical computerized tomography (CT) and magnetic resonance imaging (MRI) are used for staging of hepatocellular carcinoma (HCC) prior to curative treatments but underestimate tumor extension in 30% to 50% of cases when compared with pathologic explants. This study compares a new technology, MRI angiography (MRA), with triphasic helical CT in detection of HCC. Fifty cirrhotic patients, 29 with HCC, undergoing liver transplantation were analyzed. MRA was performed with a 3-D breath-hold fast spoiled gradient-echo sequence by using an effective section thickness of 2 to 2.5 mm. The gold standard was the pathologic examination (liver cut into 5-mm slices). One hundred twenty-seven lesions were identified at the explant: 76 HCC, 13 high-grade dysplastic nodules, 31 macroregenerative nodules, 7 hemangiomas. Diameter of the main HCC nodules was 29 ± 14 mm and 11 ± 7 mm for the 47 additional nodules. On a per nodule basis, sensitivity of MRA was superior to CT (58/76 [76%] vs. 43/70 [61%], respectively, P = .001). Sensitivity of MRA for detection of additional nodules decreased with size (> 20 mm: 6/6 [100%] ; 10-20 mm: 16/19 [84%]; < 10 mm: 7/22 [32%]) and was superior to CT for nodules 10 to 20 mm (84% vs. 47%, P = .016). Nonspecific hypervascular nodules > 5 mm at MRA were HCC in two thirds of the cases. In conclusion, MRA has a high diagnostic accuracy for HCC ≥10 mm and is more sensitive than triphasic helical CT in nodules sized 10 to 20 mm. MRA is the optimal technique for HCC staging prior to curative therapies.
UR - http://www.scopus.com/inward/record.url?scp=0141643384&partnerID=8YFLogxK
U2 - 10.1053/jhep.2003.50409
DO - 10.1053/jhep.2003.50409
M3 - Article
C2 - 14512891
AN - SCOPUS:0141643384
SN - 0270-9139
VL - 38
SP - 1034
EP - 1042
JO - Hepatology
JF - Hepatology
IS - 4
ER -