Spiral computed tomography versus ultrasound in the follow-up of cirrhotic patients previously treated for hepatocellular carcinoma: a prospective study.
OBJECTIVE
To assess the value of hepatic-arterial-phase computed tomography (HAP-CT) versus ultrasound (US) plus alpha-fetoprotein (AFP) in the surveillance of cirrhotic patients with previously treated hepatocellular carcinoma (HCC).


METHODS
Thirty-six cirrhotic patients, treated for single nodular HCC <4cm with complete response and no evidence of other focal lesions, were enrolled in a prospective study and underwent simultaneous AFP/US/spiral-CT follow-up every 6 months. Focal lesions were considered recurrences when they appeared as globular enhancement areas (EA) at HAP-CT and increased in size during the follow-up.


RESULTS
Fifteen of 36 patients showed at least one focal lesion for a total of 43 EA: 38/43 increased in size, four did not change and one disappeared. EA were first observed after a follow-up of 9+/-4 (range 6-18) months. At the same time, no patient had either nodular lesion at US examination or diagnostic levels of AFP. In 22 matched lesions, diagnosis by CT was 8.2+/-3.5 months earlier than by US. In 13 patients, one evolved EA was submitted to US-guided biopsy and histological examination showed HCC in all cases.


CONCLUSIONS
Periodical spiral-CT examination is more effective than US-AFP in early detection of HCC recurrence in cirrhotic patients successfully treated for HCC.
Colagrande
Stefano
S
Dipartimento di Fisiopatologia Clinica, Sezione di Radiologia Diagnostica, University of Florence School of Medicine, Viale Morgagni 85, 50134 Florence, Italy. s.colagrande@dfc.unifi.it
La Villa
Giorgio
G
Bartolucci
Maurizio
M
Lanini
Fabio
F
Barletta
Giuseppe
G
Villari
Natale
N
D000368:Aged; D006528:Carcinoma, Hepatocellular / Q000000981:diagnostic imaging* / Q000628:therapy; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008103:Liver Cirrhosis / Q000000981:diagnostic imaging / Q000209:etiology; D008113:Liver Neoplasms / Q000000981:diagnostic imaging* / Q000628:therapy; D008297:Male; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000000981:diagnostic imaging; D010349:Patient Compliance; D011446:Prospective Studies; D036542:Tomography, Spiral Computed; D014463:Ultrasonography