title: EASL and AASLD recommendations for the diagnosis of HCC to the test of daily practice.
abstract: To evaluate the diagnostic performance of CT, MRI and CEUS alone and in combination, for the diagnosis of HCC between 10 and 30 mm, in a large population of cirrhotic patients.
  
  
  
  In a multicentre prospective trial, 442 patients have been enrolled. Within a month, CEUS, CT and MRI were performed for all patients. A composite algorithm was defined to obtain the more accurate gold standard.
  
  
  
  A total of 544 nodules in 381 patients have been retained for the performance analysis. Eighty-two percent of the patients were male, mean age was 62 years. For the 10-20 mm nodules (n=342), the sensitivity (Se) and specificity (Sp) for the diagnosis of HCC were, respectively, 70.6% and 83.2% for MRI, 67.9% and 76.8% for CT and 39.6% and 92.9% for CEUS. For the 20-30 mm nodules (n=202), the Se and Sp were, respectively, 72.3% and 89.4% for MRI, 71.6% and 93.6% for CT and 52.9% and 91.5% for CEUS. THE BEST COMBINATION FOR THE 10-20 MM NODULES WAS MRI + CT (SE: 55.1%, SP: 100.0%).: After a first inconclusive technique, CEUS as second image technique allowed the highest specificity with only a slight drop of sensitivity for 10-20 mm nodules and the highest sensitivity and specificity for 20-30 mm nodules.
  
  
  
  This large multicentre study validates the EASL/AASLD recommendations in daily practice. Specificity using CT or MRI in 10-20 mm HCC was low, but we do not recommend combined imaging at first as sensitivity would be very low. The best sequential approach combined MRI and CEUS.
authors.affiliation: Département de Radiologie, CHU d'Angers, Université Bretagne Loire, Angers, France.|Laboratoire HIFIH, Université Bretagne Loire, Université d'Angers, Angers, France.
authors.forename: Christophe
authors.identifier: 0000-0003-3326-2456
authors.initials: C
authors.lastname: Aubé
authors.affiliation: Laboratoire HIFIH, Université Bretagne Loire, Université d'Angers, Angers, France.|Service de Gastroenterologie et Hépatologie, Université Bretagne Loire, CHU d'Angers, Angers, France.
authors.forename: Frédéric
authors.initials: F
authors.lastname: Oberti
authors.affiliation: Département de Radiologie, CHU Saint Eloi, Université de Montpellier, Montpellier, France.
authors.forename: Julie
authors.initials: J
authors.lastname: Lonjon
authors.affiliation: Département d'hépatogastroentérologie, CHU Saint Eloi, Université de Montpellier, Montpellier, France.
authors.forename: Georges
authors.initials: G
authors.lastname: Pageaux
authors.affiliation: Service de Radiologie, Hôpital Jean Verdier, Hôpitaux universitaires Paris-Seine-Saint-Denis, Assistance publique Hôpitaux de Paris, Bondy, France.|Unité mixte de Recherche 1162, Génomique fonctionnelle des Tumeurs solides, Institut National de la Santé et de la Recherche médicale, Paris, France.|Unité de Formation et de Recherche Santé Médecine et Biologie humaine, Université Paris 13, Communauté d'Universités et Etablissements Sorbonne Paris Cité, Paris, France.
authors.forename: Olivier
authors.initials: O
authors.lastname: Seror
authors.affiliation: Service d'hépato gastroentérologie, Hôpital Jean Verdier, Hôpitaux Universitaires Paris-Seine-Saint-Denis, Assistance publique Hôpitaux de Paris, Bondy, France.
authors.forename: Giséle
authors.initials: G
authors.lastname: N'Kontchou
authors.affiliation: Département de Radiologie, Hôpital de la Croix Rousse, CHU Lyon, Lyon, France.
authors.forename: Agnes
authors.initials: A
authors.lastname: Rode
authors.affiliation: Service d'hépatologie, Hôpital de la croix rousse, Unité INSERM 1052, CHU Lyon, Lyon, France.
authors.forename: Sylvie
authors.initials: S
authors.lastname: Radenne
authors.affiliation: Département d'imagerie diagnostique et interventionnelle, Hôpital Haut-Lévèque, CHU Bordeaux, Pessac, France.
authors.forename: Christophe
authors.initials: C
authors.lastname: Cassinotto
authors.affiliation: Service Hépato-gastroentérologie, CHU de Bordeaux, Hôpital Haut-Lévêque, Pessac, France.
authors.forename: Julien
authors.initials: J
authors.lastname: Vergniol
authors.affiliation: Département d'imagerie, Radiologie et imagerie médicale, CHU, Grenoble, France.|Laboratory of Techniques for Biomedical Engineering And Complexity Management - Informatics, Mathematics and Applications, Université Grenoble Alpes, Grenoble, France.
authors.forename: Ivan
authors.initials: I
authors.lastname: Bricault
authors.affiliation: Service d'hépato gastroentérologie, University Hospital, Grenoble, France.
authors.forename: Vincent
authors.initials: V
authors.lastname: Leroy
authors.affiliation: Département de Radiologie, Hôpital Beaujon, Hôpitaux Paris Nord Val de Seine (AP-HP), Clichy, France.
authors.forename: Maxime
authors.initials: M
authors.lastname: Ronot
authors.affiliation: Service d'hépatologie, Hôpital Beaujon, Assistance Publique-Hopitaux de Paris, Clichy, France.|Université Paris Diderot, Sorbonne Paris Cité, CRI, U1149, Paris, France.
authors.forename: Laurent
authors.initials: L
authors.lastname: Castera
authors.affiliation: Département d'anatomopatologie, CHU d'Angers, LUNAM Université, Angers, France.
authors.forename: Sophie
authors.initials: S
authors.lastname: Michalak
authors.affiliation: Assistance Publique - Hôpitaux de Paris, Hôpital européen Georges-Pompidou, Unité d'Épidémiologie et de Recherche Clinique, Paris, France.|INSERM, Centre d'Investigation Clinique 1418, module Épidémiologie Clinique, Paris, France.
authors.forename: Maxime
authors.initials: M
authors.lastname: Esvan
authors.affiliation: Université Paris Diderot, Sorbonne Paris Cité, CRI, U1149, Paris, France.|Département de Radiologie, Hôpital Beaujon, Hôpitaux Paris Nord Val de Seine (AP-HP), Clichy, France.
authors.forename: Valérie
authors.initials: V
authors.lastname: Vilgrain
mesh_terms: D000368:Aged; D000465:Algorithms; D006528:Carcinoma, Hepatocellular / Q000000981:diagnostic imaging* / Q000473:pathology; D003287:Contrast Media / Q000008:administration & dosage; D003661:Decision Support Techniques; D005260:Female; D005602:France; D006801:Humans; D008113:Liver Neoplasms / Q000000981:diagnostic imaging* / Q000473:pathology; D008279:Magnetic Resonance Imaging / Q000592:standards; D008297:Male; D008875:Middle Aged; D064847:Multimodal Imaging; D011237:Predictive Value of Tests; D011446:Prospective Studies; D015203:Reproducibility of Results; D014057:Tomography, X-Ray Computed / Q000592:standards; D047368:Tumor Burden; D014463:Ultrasonography / Q000592:standards
chemical_list: D003287:Contrast Media
keywords: Contrast-enhanced ultrasound; hepatocellular carcinoma; magnetic resonance imaging; multidetector computed tomography