Size discrepancy between sonographic and computed tomographic/magnetic resonance imaging measurement of hepatocellular carcinoma: the necessity of tumor size measurement standardization.
OBJECTIVE
There is no standardized method for size measurement of hepatocellular carcinoma. The purpose of this study was to evaluate whether the size and stage of hepatocellular carcinoma differ according to the imaging modality.


METHODS
This retrospective study was approved by our Institutional Review Board, and written informed consent was waived. Patients with hepatocellular carcinoma who underwent either computed tomography (CT) or magnetic resonance imaging (MRI) along with planning sonography for radiofrequency ablation on the same day were included. A total of 113 patients with 127 hepatocellular carcinomas were included. The sizes of the tumors were measured and the tumor stages were assessed on CT/MRI and sonography. The results were compared by a t test, Bland-Altman limits of agreement, and a McNemar test.


RESULTS
There was a significant difference in the hepatocellular carcinoma size between CT/MRI and sonographic measurements (mean difference, 0.26 cm; P < .0001). The sizes of 102 tumors (80.3%) were larger on sonography than on CT/MRI. Twelve tumors (9.5%) were the same size and 13 (10.2%) were smaller on sonography than on CT/MRI. There was also difference in the tumor stage (very early or not) between CT/MRI and sonography (P= .006, McNemar test). The stage was discordant in 16 of 127 tumors (12.6%). Among 69 tumors at the very early stage on CT/MRI, 14 (20.3%) were beyond the very early stage on sonography.


CONCLUSIONS
The size of hepatocellular carcinoma measured on sonography tends to be larger than on CT/MRI; therefore, the tumor stage can differ between sonography and CT/MRI.
Department of Radiology and Center for Imaging Science, Samsung Medical Center, Sungkyunkwan University School of Medicine, 50 Ilwon-Dong, Kangnam-Ku, Seoul 135-710, Korea. leeminwoo0@gmail.com.
Min Jae
MJ
Cha
Min Woo
MW
Lee
Dong Ik
DI
Cha
Jae-Hun
JH
Kim
Hyunchul
H
Rhim
Yun Ku
YK
Cho
Young Jun
YJ
Kim
Dongil
D
Choi
Young-sun
YS
Kim
Hyo K
HK
Lim
D006528:Carcinoma, Hepatocellular / Q000175:diagnosis* / Q000453:epidemiology* / Q000601:surgery; D005260:Female; D006801:Humans; D008113:Liver Neoplasms / Q000175:diagnosis* / Q000453:epidemiology* / Q000601:surgery; D008279:Magnetic Resonance Imaging / Q000592:standards / Q000706:statistics & numerical data*; D008297:Male; D008875:Middle Aged; D064847:Multimodal Imaging / Q000592:standards / Q000706:statistics & numerical data; D011300:Preoperative Care / Q000592:standards / Q000706:statistics & numerical data; D015995:Prevalence; D011379:Prognosis; D012015:Reference Standards; D015203:Reproducibility of Results; D056910:Republic of Korea / Q000453:epidemiology; D018570:Risk Assessment; D012680:Sensitivity and Specificity; D014057:Tomography, X-Ray Computed / Q000592:standards / Q000706:statistics & numerical data*; D047368:Tumor Burden; D014463:Ultrasonography / Q000592:standards / Q000706:statistics & numerical data*
computed tomography; hepatocellular carcinoma; magnetic resonance imaging; size; sonography; stage