EASL和AASLD建议用于诊断HCC进行日常实践

StephenW

Original Article
EASL and AASLD recommendations for the diagnosis of HCC to the test of daily practice
Authors

    Christophe Aubé,

    Frederic Oberti,
    Julie Lonjon,
    Georges Pageaux,
    Olivier Seror,
    Giséle N'Kontchou,
    Agnes Rode,
    Sylvie Radenne,
    Christophe Cassinotto,
    Julien Vergniol,
    Ivan Bricault,
    Vincent Leroy,
    Maxime Ronot,
    Laurent Castera,
    Sophie Michalak,
    Maxime Esvan,
    Valérie Vilgrain,
    The CHIC group

    Accepted manuscript online: 27 March 2017Full publication history
    DOI: 10.1111/liv.13429  View/save citation
    Cited by (CrossRef): 0 articles Check for updates

    This article has been accepted for publication and undergone full peer review but has not been through the copyediting, typesetting, pagination and proofreading process, which may lead to differences between this version and the Version of Record. Please cite this article as doi: 10.1111/liv.13429

Abstract
Aim

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.
Patients and Methods

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.
Results

544 nodules in 381 patients have been retained for the performance analysis. Patients were 82% of male, mean age was 62 years. For the 10–20mm 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 20–30mm 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 10-20mm nodules was MR + 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 10-20mm nodules and the highest sensitivity and specificity for 20-30mm nodules.
Conclusion

This large multicentre study validates the EASL/AASLD recommendations in daily practice. Specificity using CT or MRI in 10-20mm 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.

This article is protected by copyright. All rights reserved.

StephenW

来源文章
EASL和AASLD建议用于诊断HCC进行日常实践
作者

    克里斯托夫·奥比（ChristopheAubé）

    弗雷德里克·奥伯蒂，
    Julie Lonjon，
    乔治·赛克
    Olivier Seror，
    GiséleN'Kontchou，
    阿格尼丝·罗德，
    Sylvie Radenne，
    克里斯托夫·卡西诺托，
    Julien Vergniol，
    伊万·布里克，
    Vincent Leroy，
    Maxime Ronot，
    Laurent Castera，
    Sophie Michalak，
    Maxime Esvan，
    ValérieVilgrain，
    CHIC集团

    在线接受手稿：2017年3月27日全面的出版历史
    DOI：10.1111 / liv.13429查看/保存引用
    引用（CrossRef）：0篇文章检查更新

    本文已被接受发布并经过全面的同行评议，但尚未通过编辑，排版，分页和校对过程，这可能导致此版本与版本记录之间的差异。请引用本文作为doi：10.1111 / liv.13429

抽象
目标

为了评估CT，MRI和CEUS单独和联合的诊断性能，用于在大量肝硬化患者中诊断为10〜30mm的HCC。
患者和方法

在多中心前瞻性试验中，已有442例患者入选。在一个月内，所有患者都进行了CEUS，CT和MRI检查。定义了复合算法，以获得更准确的金标准。
结果

保留了381例患者的544例结节进行性能分析。患者为男性82％，平均年龄为62岁。对于10-20mm结节（n = 342），肝癌诊断的敏感性（Se）和特异性（Sp）分别为MRI分别为70.6％和83.2％，CT分别为67.9％和76.8％，分别为39.6％和92.9 ％为CEUS。对于20-30mm结节（n = 202），Se和Sp分别为MRI分别为72.3％和89.4％，CT分别为71.6％和93.6％，CEUS分别为52.9％和91.5％。 10-20mm结节的最佳组合是MR + CT（Se：55.1％，Sp：100.0％）在第一次不确定的技术之后，CEUS作为第二图像技术允许最高的特异性，只有轻微的灵敏度下降10-20mm结节和20-30mm结节的最高灵敏度和特异性。
结论

这项大型多中心研究证实了日常实践中的EASL / AASLD建议。在10-20mm HCC中使用CT或MRI的特异性较低，但首先不建议使用组合成像，因为灵敏度非常低。联合MRI和CEUS的最佳顺序方法。

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