Accuracy and disagreement of computed tomography and magnetic resonance imaging for the diagnosis of small hepatocellular carcinoma and dysplastic nodules: Role of biopsy

Authors

  • Thomas Sersté,

    1. Assistance-Publique Hôpitaux de Paris, APHP Service d'Hépatologie, Hôpital Beaujon, Clichy, France
    2. Hepato-Gastroentérologie, Hôpital Saint-Pierre, Université Libre de Bruxelles, Bruxelles, Belgium
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  • Vincent Barrau,

    1. Assistance-Publique Hôpitaux de Paris, APHP, Hôpital Beaujon, Departement de Radiologie, Clichy, France
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  • Violaine Ozenne,

    1. Assistance-Publique Hôpitaux de Paris, APHP Service d'Hépatologie, Hôpital Beaujon, Clichy, France
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  • Marie-Pierre Vullierme,

    1. Assistance-Publique Hôpitaux de Paris, APHP, Hôpital Beaujon, Departement de Radiologie, Clichy, France
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  • Pierre Bedossa,

    1. Service d'Anatomo-Pathologie, Hôpital Beaujon, Clichy, France
    2. Université Paris Diderot, Sorbonne Paris Cité, INSERM Centre de Recherche Biomédicale Bichat Beaujon, CRB3 U773 75018 Paris, France
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  • Olivier Farges,

    1. Service de Chirurgie, Hôpital Beaujon, Clichy, France
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  • Dominique-Charles Valla,

    1. Assistance-Publique Hôpitaux de Paris, APHP Service d'Hépatologie, Hôpital Beaujon, Clichy, France
    2. Université Paris Diderot, Sorbonne Paris Cité, INSERM Centre de Recherche Biomédicale Bichat Beaujon, CRB3 U773 75018 Paris, France
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  • Valérie Vilgrain,

    1. Assistance-Publique Hôpitaux de Paris, APHP, Hôpital Beaujon, Departement de Radiologie, Clichy, France
    2. Université Paris Diderot, Sorbonne Paris Cité, INSERM Centre de Recherche Biomédicale Bichat Beaujon, CRB3 U773 75018 Paris, France
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  • Valérie Paradis,

    1. Service d'Anatomo-Pathologie, Hôpital Beaujon, Clichy, France
    2. Université Paris Diderot, Sorbonne Paris Cité, INSERM Centre de Recherche Biomédicale Bichat Beaujon, CRB3 U773 75018 Paris, France
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  • Françoise Degos

    Corresponding author
    1. Assistance-Publique Hôpitaux de Paris, APHP Service d'Hépatologie, Hôpital Beaujon, Clichy, France
    • Hopital Beaujon, Service d'Hepatologie, 100 Boulevard du Général Leclerc, 92118 Clichy, France
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    • Fax: (33)-01-47-30-94-40


  • Potential conflict of interest: Nothing to report.

Abstract

Liver macronodules, ranging from benign to low-grade or high-grade dysplastic nodules (LGDNs/HGDNs) and hepatocellular carcinoma (HCC), may develop during chronic liver diseases (CLDs). Current guidelines were recently updated and the noninvasive criteria for the diagnosis of small HCC are based on a single typical radiological pattern and nonconclusive coincidental findings with two techniques. This study aimed to assess the accuracy and disagreements of noninvasive multiphasic examinations for the diagnosis of HCC and dysplastic nodules (DNs) and the role of biopsy. Seventy-four consecutive patients with CLD with ultrasound-detected 1-2-cm nodules underwent, within 1 month, multiphasic computed tomography (CT), magnetic resonance imaging (MRI), and biopsy of the nodule. Median age was 60 years; 33 patients (45%) had hepatitis C virus, 20 (27%) had hepatitis B virus, and 13 (18%) patients had no cirrhosis. Biopsy revealed 47 HCCs, 6 HGDNs, 1 LGDNs, 1 cholangiocarcinoma, and 1 epithelioid hemangioendothelioma. There were no tumors in the other 18 patients. All patients (31 of 31; 100%) who had conclusive coincidental findings (i.e., arterial enhancement and washout) on both examinations had HCC or HGDN (sensitivity, 57%; specificity, 100%). All patients (51 of 51; 100%) who had conclusive findings on at least one of the two examinations had HCC or HGDN (sensitivity, 96%; specificity, 100%). There was a disagreement regarding imaging findings between CT and MRI in 21 of 74 (28%) patients and no washout on both examinations in 23 of 74 patients (31%). In these 44 patients, liver biopsy provided an initial accurate diagnosis. Conclusion: The noninvasive diagnosis of HCC or HGDN can be obtained if arterial enhancement and washout are found in a single dynamic imaging examination. These findings are frequently discordant on both CT and MRI, supporting the place of biopsy for the diagnosis of small HCCs. (HEPATOLOGY 2011)

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