Alessandro Furlan MD, Presenter: Nothing to Disclose

Daniele Marin MD, Abstract Co-Author: Fellowship funded, Bracco Group

Francesco Agnello MD, Abstract Co-Author: Nothing to Disclose

Adele Taibbi MD, Abstract Co-Author: Nothing to Disclose

Paolo Cabassa MD, Abstract Co-Author: Nothing to Disclose

Giuseppe Brancatelli MD, Abstract Co-Author: Speakers Bureau, Bayer AG

Tommaso Vincenzo Bartolotta MD, Abstract Co-Author: Nothing to Disclose

Massimo Midiri MD, Abstract Co-Author: Nothing to Disclose

To prospectively assess the agreement among contrast-enhanced ultrasound (CEUS), multiphasic multi-detector row CT (MDCT), and magnetic resonance imaging (MRI) for the detection of enhancement pattern of small (≤2cm) HCCs in cirrhotic patients.

The study cohort comprised 97 cirrhotic patients (73M, 24F, mean age, 68 years) with 106 confirmed small (mean, 1.5 cm; range, 0.6-2.0 cm) HCCs. Subjects underwent CEUS and MDCT (n=59 with 62 lesions), CEUS and MRI (n=27 with 29 lesions), or MDCT and MRI (n=11 with 15 lesions), within 15 days. Three experienced radiologists in consensus qualitatively evaluated the images and assessed presence of hypervascularity on hepatic arterial phase, and presence of washout on hepatic venous and/or delayed phases. According to the AASLD guidelines typical enhancement pattern was defined as the combination of tumor hypervascularity and washout. Intermodality agreement for visualization of hypervascularity, washout and typical enhancement pattern, was assessed calculating Cohen’s kappa coefficient (k) and proportion of agreement when k-statistic could not be assessed.

CEUS and MDCT had fair agreement in the detection of hypervascularity (51/62 vs. 57/62, k=.227), and only slight agreement for the assessment of both washout (34/62 vs 57/62, k=.122), and typical enhancement pattern (30/62 vs. 50/62, k=.178). CEUS and MRI showed moderate agreement in assessing hypervascularity (22/29 vs. 26/29, k=.532), slight agreement for washout (25/29 vs. 28/29, k=.058), and fair agreement for detection of typical enhancement pattern (20/29 vs. 25/29, k=.334). The agreement between MDCT and MRI was excellent for assessing tumor hypervascularity (12/15 vs. 11/15, k=.815), and substantial for typical enhancement pattern (11/15 vs. 11/15, k=.659); washout was deemed present in 14/15 lesions at MDCT and in all 15 lesions at MRI (proportion of agreement=93%).

The intermodality agreement for the detection of typical enhancement pattern of HCC is highest using a combination of MDCT and MRI, and lowest using CEUS in combination with MDCT.

According to the latest AASLD guidelines, diagnosis of small (≤2cm) HCC is achieved when typical enhancement pattern is detected by two contrast-enhanced imaging studies.

Furlan, A, Marin, D, Agnello, F, Taibbi, A, Cabassa, P, Brancatelli, G, Bartolotta, T, Midiri, M, Intermodality Agreement for the Assessment of Enhancement Pattern of Small (≤2cm) Hepatocellular Carcinoma (HCC) in Cirrhotic Patient.  Radiological Society of North America 2010 Scientific Assembly and Annual Meeting, November 28 - December 3, 2010 ,Chicago IL. http://archive.rsna.org/2010/9009396.html