The added diagnostic value of 64-row multidetector CT combined with contrast-enhanced US in the evaluation of hepatocellular nodule vascularity: implications in the diagnosis of malignancy in patients with liver cirrhosis
by Quaia E., Alaimo V., Baratella E., Baratella E., Medeot A., Midiri M., Cova MA
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Abstract
The aim of this study was to assess the added diagnostic value of
contrast-enhanced US (CEUS) combined with 64-row multidetector CT (CT) in the assessment of
hepatocellular nodule vascularity in patients with liver cirrhosis. One hundred and six cirrhotic
patients (68 male, 38 female; mean age ± SD, 70±7 years) with 121 biopsy-proven hepatocellular
nodules (72 hepatocellular carcinomas, 10 dysplastic and 15 regenerative nodules, 12 hemangiomas,
and 12 other benignancies) detected during US surveillance were prospectively recruited. Each
nodule was scanned by CEUS during the arterial (10–40 s), portal venous (45–90 s), and delayed
sinusoidal phase (from 100 s after microbubble injection to microbubble disappearance). Nodule
vascularity at CEUS, CT, and combined CEUS/CT was evaluated side-by-side by two independent blinded
readers who classified nodules as benign or malignant according to reference diagnostic criteria.
The combined assessment of CEUS/CT provided higher sensitivity (97%, both readers) than did
separate assessment of CEUS (88% reader 1; 87% reader 2) and CT (74% reader 1; 71% reader 2;
P<0.05), while no change in specificity was provided by combined analysis. The combined
assessment of hepatocellular nodule vascularity at CT and CEUS improved sensitivity in the
diagnosis of malignancy in patients with liver cirrhosis.
