title: Alpha fetoprotein, ultrasound, computerized tomography and magnetic resonance imaging for detection of hepatocellular carcinoma in patients with advanced cirrhosis.
abstract: BACKGROUND
  Serum alpha fetoprotein (AFP), ultrasound, computerized tomography scanning, and magnetic resonance imaging are commonly used to screen for hepatocellular carcinoma (HCC) in patients with cirrhosis.
  
  
  OBJECTIVE
  To assess the accuracy of screening in advanced cirrhosis.
  
  
  METHODS
  The study group consisted of 239 patients with proven HCC in the explanted liver at the time of liver transplant. AFP and imaging were done at referral and serially until transplant.
  
  
  RESULTS
  Hepatocellular carcinoma was detected before liver transplant in 78% and discovered incidentally in 22%. The cause of cirrhosis was hepatitis C (HCV) (55%), hepatitis B (HBV) (17%), alcohol (9%), and other/unknown (19%). Although AFP was elevated 62%, the median level was 15 ng/mL. Only 26%, 15% and 13% were more than 100, 400 and 1000 ng/mL, respectively. By comparison, AFP was elevated in 20% without HCC, but exceeded 100 ng/mL in only 3%. The overall accuracy of AFP was poor regardless of the cutoff. Magnetic resonance imaging was more accurate than computerized tomography or ultrasound in detecting tumour, particularly when performed within 3 months of transplant.
  
  
  CONCLUSIONS
  Magnetic resonance imaging is most sensitive for imaging HCC and best reflects actual tumour size. AFP is insensitive and adds little to screening strategies, but has prognostic value when extremely elevated.
authors.affiliation: Department of Medicine, Baylor University Medical Center, Dallas, TX, USA.
authors.forename: N
authors.initials: N
authors.lastname: Snowberger
authors.forename: S
authors.initials: S
authors.lastname: Chinnakotla
authors.forename: R M
authors.initials: RM
authors.lastname: Lepe
authors.forename: J
authors.initials: J
authors.lastname: Peattie
authors.forename: R
authors.initials: R
authors.lastname: Goldstein
authors.forename: G B
authors.initials: GB
authors.lastname: Klintmalm
authors.forename: G L
authors.initials: GL
authors.lastname: Davis
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D006528:Carcinoma, Hepatocellular / Q000175:diagnosis* / Q000000981:diagnostic imaging; D005260:Female; D006801:Humans; D008103:Liver Cirrhosis / Q000175:diagnosis* / Q000000981:diagnostic imaging; D008113:Liver Neoplasms / Q000175:diagnosis* / Q000000981:diagnostic imaging; D016031:Liver Transplantation; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D012680:Sensitivity and Specificity; D014057:Tomography, X-Ray Computed; D014463:Ultrasonography; D000509:alpha-Fetoproteins / Q000378:metabolism*
chemical_list: D000509:alpha-Fetoproteins