title: Real time elastography - a non-invasive diagnostic method of small hepatocellular carcinoma in cirrhosis.
abstract: BACKGROUND
  Small nodules (under 3 cm) detected on ultrasound (US) in cirrhotics represent the most challenging category for noninvasive diagnosis of hepatocellular carcinoma (HCC).
  
  
  OBJECTIVE
  To evaluate real-time sonoelastography as a noninvasive tool for the diagnosis of small HCC nodules in cirrhotic patients.
  
  
  METHODS
  42 cirrhotic patients with 58 nodules (1-3 cm) were evaluated with real-time elastography (Hitachi EUB-6500); the mean intensity of colors red, blue, green were measured using a semi-quantitative method. Analysis of histograms for each color of the sonoelastography images was performed for quantifying the elasticity of nodule tissue in comparison with the cirrhotic liver tissue. AUROC curves were constructed to define the best cut-off points to distinguish malignant features of the nodules. Univariate and multivariate logistic regression analysis was performed.
  
  
  RESULTS
  595 sonoelastography images from 42 patients (25 men; 17 women) were analyzed. The mean age was 56.4 +/- 0.7 years and 69% patients were in Child-Pugh class A, 19% class B, 11% class C. For the mean intensity of green color AUROC=0.81, a cut-off value under 108.7 being diagnostic for HCC with a Sp=91.1%, Se=50%, PPV=92.1%, NPV=47.1%. Mean intensity of blue color proved to be an excellent diagnostic tool for HCC (AUROC=0.94); for a cut-off value greater than 128.9, Sp=92.2%, Se=78.9%, PPV=95.4%, NPV=68%. Independent predictive factors of HCC for a small nodule in cirrhotic patients were: blue color over 128.9 at sonoelastography and hypervascular appearance at Doppler US.
  
  
  CONCLUSIONS
  US elastography is a promising method for the non-invasive diagnosis of early HCC. Blue color at elastography and hypervascular aspects are independent predictors of HCC.
authors.affiliation: Fundeni Clinical Institute of Digestive Diseases, Liver Transplantation, Bucharest, Romania. drgheorghe@xnet.ro
authors.forename: Liana
authors.initials: L
authors.lastname: Gheorghe
authors.forename: Speranta
authors.initials: S
authors.lastname: Iacob
authors.forename: Razvan
authors.initials: R
authors.lastname: Iacob
authors.forename: Mona
authors.initials: M
authors.lastname: Dumbrava
authors.forename: Gabriel
authors.initials: G
authors.lastname: Becheanu
authors.forename: Vlad
authors.initials: V
authors.lastname: Herlea
authors.forename: Cristian
authors.initials: C
authors.lastname: Gheorghe
authors.forename: Ioana
authors.initials: I
authors.lastname: Lupescu
authors.forename: Irinel
authors.initials: I
authors.lastname: Popescu
mesh_terms: D000368:Aged; D006528:Carcinoma, Hepatocellular / Q000000981:diagnostic imaging* / Q000209:etiology; D016009:Chi-Square Distribution; D055088:Early Detection of Cancer; D054459:Elasticity Imaging Techniques; D005260:Female; D006801:Humans; D007090:Image Interpretation, Computer-Assisted; D008103:Liver Cirrhosis / Q000150:complications / Q000000981:diagnostic imaging*; D008113:Liver Neoplasms / Q000000981:diagnostic imaging* / Q000209:etiology; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D011237:Predictive Value of Tests; D012372:ROC Curve; D012720:Severity of Illness Index; D018615:Ultrasonography, Doppler, Color