title: Improving the prediction of hepatocellular carcinoma in cirrhotic patients with an arterially-enhancing liver mass.
abstract: In the United States, cirrhotic patients with known or suspected hepatocellular carcinoma (HCC) are prioritized for liver transplantation. Noninvasive criteria for the diagnosis of HCC rely on arterial enhancement of a mass. The aim of this study was to determine whether clinical, laboratory, and / or radiologic data can improve the prediction of HCC in cirrhotic patients with an arterially-enhancing mass. Between May 2002 and June 2003, dynamic gadolinium-enhanced magnetic resonance imaging (MRI) of consecutive patients with liver cirrhosis and a solid mass were reviewed by 2 radiologists blinded to the clinical diagnosis. Clinical, laboratory, and radiologic data were recorded for all patients. A total of 94 patients with cirrhosis and an arterially-enhancing liver mass were studied, 66 (70%) of whom had HCC. Alpha-fetoprotein (AFP) >20 ng/mL (P = .029), tumor size >2 cm (P = .0018), and delayed hypointensity (P = .0001) were independent predictors of HCC. Delayed hypointensity of an arterially-enhancing mass had a sensitivity of 89% and a specificity of 96% for HCC. The presence of delayed hypointensity was the only independent predictor of HCC among patients with arterially-enhancing lesions <2 cm (odds ratio, 6.3; 95% confidence interval [CI], 1.8-13), with a sensitivity of 80% and a specificity of 95%. In conclusion, delayed hypointensity of an arterially-enhancing mass was the strongest independent predictor of HCC, regardless of the size of the lesion. If additional studies confirm our results, the noninvasive criteria utilized to make a diagnosis of HCC should be revised.
authors.affiliation: Division of Gastroenterology, Department of Internal Medicine, University of Michigan, Ann Arbor, MI 48109-0362, USA. jmarrero@umich.edu
authors.forename: Jorge A
authors.initials: JA
authors.lastname: Marrero
authors.forename: Hero K
authors.initials: HK
authors.lastname: Hussain
authors.forename: Hahn V
authors.initials: HV
authors.lastname: Nghiem
authors.forename: Ramsey
authors.initials: R
authors.lastname: Umar
authors.forename: Robert J
authors.initials: RJ
authors.lastname: Fontana
authors.forename: Anna S
authors.initials: AS
authors.lastname: Lok
mesh_terms: D006528:Carcinoma, Hepatocellular / Q000000981:diagnostic imaging / Q000601:surgery*; D005260:Female; D006801:Humans; D008099:Liver / Q000033:anatomy & histology*; D008103:Liver Cirrhosis / Q000209:etiology / Q000601:surgery*; D008113:Liver Neoplasms / Q000000981:diagnostic imaging / Q000601:surgery*; D016031:Liver Transplantation / Q000379:methods*; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D018579:Patient Selection; D011859:Radiography; D016896:Treatment Outcome; D000509:alpha-Fetoproteins / Q000032:analysis
chemical_list: D000509:alpha-Fetoproteins