title: Hepatocellular carcinoma in cirrhotic patients: prospective comparison of US, CT and MR imaging.
abstract: OBJECTIVE
  To prospectively compare the diagnostic performance of ultrasound (US), multidetector computed tomography (MDCT) and contrast-enhanced magnetic resonance imaging (MRI) in cirrhotic patients who were candidates for liver transplantation.
  
  
  METHODS
  One hundred and forty consecutive patients with 163 hepatocellular carcinoma (HCC) nodules underwent US, MRI and MDCT. Diagnosis of HCC was based on pathological findings or substantial growth at 12-month follow-up. Four different image datasets were evaluated: US, MDCT, MRI unenhanced and dynamic phases, MRI unenhanced dynamic and hepatobiliary phase. Diagnostic accuracy, sensitivity, specificity, PPV and NPV, with corresponding 95 % confidence intervals, were determined. Statistical analysis was performed for all lesions and for three lesion subgroups (<1 cm, 1-2 cm, >2 cm).
  
  
  RESULTS
  Significantly higher diagnostic accuracy, sensitivity and NPV was achieved on dynamic + hepatobiliary phase MRI compared with US, MDCT and dynamic phase MRI alone. The specificity and PPV of US was significantly lower than that of MDCT, dynamic phase MRI and dynamic + hepatobiliary phase MRI. Similar results were obtained for all sub-group analyses, with particular benefit for the diagnosis of smaller lesions between 1 and 2 cm.
  
  
  CONCLUSIONS
  Dynamic + hepatobiliary phase MRI improved detection and characterisation of HCC in cirrhotic patients. The greatest benefit is for diagnosing lesions between 1 and 2 cm.
authors.affiliation: Department of Radiological Sciences, Oncology and Anatomical Pathology, University of Rome "Sapienza", Viale Regina Elena 324, Rome 00161, Italy.
authors.forename: Michele
authors.initials: M
authors.lastname: Di Martino
authors.forename: Gianmaria
authors.initials: G
authors.lastname: De Filippis
authors.forename: Adriano
authors.initials: A
authors.lastname: De Santis
authors.forename: Daniel
authors.initials: D
authors.lastname: Geiger
authors.forename: Maurizio
authors.initials: M
authors.lastname: Del Monte
authors.forename: Concetta Valentina
authors.initials: CV
authors.lastname: Lombardo
authors.forename: Massimo
authors.initials: M
authors.lastname: Rossi
authors.forename: Stefano Ginanni
authors.initials: SG
authors.lastname: Corradini
authors.forename: Gianluca
authors.initials: G
authors.lastname: Mennini
authors.forename: Carlo
authors.initials: C
authors.lastname: Catalano
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D006528:Carcinoma, Hepatocellular / Q000150:complications / Q000175:diagnosis*; D006801:Humans; D008103:Liver Cirrhosis / Q000150:complications / Q000175:diagnosis*; D008113:Liver Neoplasms / Q000150:complications / Q000175:diagnosis*; D008279:Magnetic Resonance Imaging / Q000379:methods*; D008297:Male; D008875:Middle Aged; D015203:Reproducibility of Results; D012680:Sensitivity and Specificity; D014057:Tomography, X-Ray Computed / Q000379:methods*; D014463:Ultrasonography / Q000379:methods*; D055815:Young Adult