DOI:10.2214/AJR.06.1689
AJR 2007; 188:W494
© American Roentgen Ray Society
Utility of Sonography in Diagnosing Hepatocellular Carcinoma
Giovanni Tarantino
Federico II University, Medical School of Naples, Naples,
Italy
WEB—This is a Web exclusive article.
Viral-related cirrhosis is a leading risk factor for hepatocellular
carcinoma (HCC). Mortality due to HCC has not improved because of the poor
performance of available tumor markers, leading to delays in diagnosis.
Treatment options are limited and often inefficient. Percutaneous ethanol
injection therapy appears to be as safe and effective as resection, and both
treatments can be considered first-line options for small HCC. Transarterial
chemoembolization or percutaneous ethanol injection therapy or both offer a
median survival range of 16 to 24 months.
A recent study fixed the best cutoff value for 
-fetoprotein to
discriminate between liver cirrhosis and HCC at 30 ng/mL (sensitivity, 65%;
specificity, 89%; positive predictive value [PPV], 74%)
[1]. With the widespread use of
sonography, the usefulness of -fetoprotein assay in the diagnosis of
HCC has decreased. Some authors, attempting to assess the diagnostic
performance of contrast administration for detection of HCC, use
contrast-enhanced sonography to characterize focal hepatic lesions in patients
with diffuse liver disease rather than baseline sonography images. These
authors obtained a better result for specific diagnosis with contrast-enhanced
sonography (sensitivity, 79%; specificity, 75%) than with baseline sonography
(sensitivity, 37%; specificity, 48%). These figures cast no doubt on the
scarce utility of basic sonography
[2]. Although there is no
definitive evidence that HCC screening in high-risk groups improves survival,
many physicians screen high-risk populations with various strategies. The most
widely used techniques are -fetoprotein and liver sonography.
When we consider the clinical and economic consequences of a common HCC
surveillance strategy in patients with viral-related cirrhosis in this
context, we can see that the outcome is poor. HCC remains the fifth most
common cancer worldwide. Do we have alternative strategies? Once intrahepatic
carcinoma nodules are suspected, sonography-guided fine-needle biopsy should
be performed as early as possible for early diagnosis and treatment.
Three-dimensional dynamic liver MRI using sensitivity encoding (SENSE) for
acquiring double arterial phase images is more efficient than
superparamagnetic iron oxide (SPIO)-enhanced MRI for detecting HCC. The mean
sensitivity and PPV of 3D dynamic imaging with SENSE were 91.3% and 89.2%,
respectively, and those of SPIO-enhanced imaging were 77.3% and 92.6%,
respectively [3].
Recently, some radiologists compared the diagnostic accuracy of
ferumoxides-enhanced MRI and gadolinium-enhanced dynamic MRI using 3D volume,
interpolatric breath-hold examination (VIBE) for the detection of HCC. The
mean sensitivity of dynamic MRI (90.7%) was significantly superior to that of
ferumoxides-enhanced MRI (80.9%). Furthermore, for lesions smaller than 1.5
cm, the mean sensitivity of dynamic MRI was significantly higher than that of
ferumoxides-enhanced MRI (85.2% vs 69.2%). Conclusively, dynamic MRI showed a
trend toward better diagnostic accuracy than ferumoxides-enhanced MRI for the
detection of HCC [4].
As a matter of fact, those tools, although better than the previous ones
for diagnosing HCC, are relatively expensive and invasive, contributing to
high and increasing health care costs. We applaud the study of Kim et al.
[2] as a strong example of
cost-containing measures.
References
- Soresi M, Magliarisi C, Campagna P, et al. Usefulness of
alpha-fetoprotein in the diagnosis of hepatocellular carcinoma.
Anticancer Res 2003;23
: 1747-1753[Medline]
- Kim SH, Lee JM, Lee JY, et al. Value of contrast-enhanced
sonography for the characterization of focal hepatic lesions in patients with
diffuse liver disease: receiver operating characteristic analysis.
AJR 2005; 184:1077
-1084[Abstract/Free Full Text]
- Kim YK, Kim CS, Kwak HS, Lee JM. Three-dimensional dynamic liver MR
imaging using sensitivity encoding for detection of hepatocellular carcinomas:
comparison with superparamagnetic iron oxide-enhanced MR imaging. J
Magn Reson Imaging 2004; 20:826
-837[CrossRef][Medline]
- Kwak HS, Lee JM, Kim YK, Lee YH, Kim CS. Detection of
hepatocellular carcinoma: comparison of ferumoxides-enhanced and
gadolinium-enhanced dynamic three-dimensional volume interpolated breath-hold
MR imaging. Eur Radiol 2005;15
: 140-147[CrossRef][Medline]
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