DOI:10.2214/AJR.06.1690
AJR 2007; 188:W495
© American Roentgen Ray Society
Reply
Jeong Min Lee
Seoul National University Hospital, Seoul, South Korea
WEB—This is a Web exclusive article.
We have read with interest the recent letter to the editor
[1] concerning diagnostic
workup in patients with diffuse liver disease, and we thank Dr. Tarantino for
his interest in our article
[2]. As Dr. Tarantino stated in
his letter, a routine surveillance program of cirrhotic patients with
abdominal sonography and 
-fetoprotein levels has been widely practiced
for the detection of hepatocellular carcinoma (HCC)
[3]. However, the findings of
various focal hepatic lesions on gray-scale baseline sonography overlap with
each other, and the specificity can be quite low
[4]. Furthermore, as mentioned
in our article, such low specificity may be compounded in special situations
associated with alterations of the echogenicity of the background hepatic
parenchyma (for example, in hepatic steatosis or liver cirrhosis)
[2].
I absolutely agree with Dr. Tarantino's closing comment that
gadolinium-enhanced dynamic MRI using a 3D gradient-echo sequence for the
detection of HCC, although better than previous techniques for diagnosing HCC,
is relatively expensive and invasive, thereby contributing to high and
continually increasing health care costs. Furthermore, unlike MRI, the use of
contrast-enhanced sonography may save the patient time in the diagnostic
workup. In our institute, if patients who are suspected of having a malignant
hepatic lesion on baseline sonography are recommended for further CT or MRI
imaging studies, they have to wait 2-4 weeks or more to undergo these studies
and have to visit the outpatient department again to obtain the final
tentative diagnosis. On the other hand, contrast-enhanced sonography can be
easily performed with baseline sonography on the same day, and the time and
effort required to perform contrast-enhanced sonography in most institutes,
including our hospital, is minimal.
Therefore, from the perspective of time and cost, contrast-enhanced
sonography may be a useful alternative to CT or MRI to detect the
characteristic arterial hypervascularization of HCC, especially in patients
with diffuse liver disease. It also offers an opportunity for patients to
receive a more specific diagnosis for their hepatic lesions in a timely and
cost-efficient manner.
References
- Utility of sonography in diagnosing hepatocellular carcinoma.
(letter) AJR 2007; 188:wxx
- 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]
- Chalasani N, Said A, Ness R, Hoen H, Lumeng L. Screening for
hepatocellular carcinoma in patients with cirrhosis in the United States:
results of a national survey Am J Gastroenterol1999; 94:2224
-2229[CrossRef][Medline]
- Nicolau C, Vilana R, Bru C. The use of contrast-enhanced ultrasound
in the management of the cirrhotic patient and for detection of HCC.Eur Radiol 2004;14
[suppl 8]:63
-71[CrossRef]
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