| 1. Armstrong GL, Wasley A, Simard EP, McQuillan GM, Kuhnert WL, Alter MJ. The prevalence of hepatitis C virus infection in the United States, 1999 through 2002. Ann Intern Med. 2006;144(10):705-714. |
Review/Other-Dx |
N/A |
To describe the HCV-infected population in the United States. |
The prevalence of anti-HCV in the United States was 1.6% (95% CI, 1.3% to 1.9%), equating to an estimated 4.1 million (CI, 3.4 million to 4.9 million) anti-HCV-positive persons nationwide; 1.3% or 3.2 million (CI, 2.7 million to 3.9 million) persons had chronic HCV infection. Peak prevalence of anti-HCV (4.3%) was observed among persons 40 to 49 years of age. A total of 48.4% of anti-HCV-positive persons between 20 and 59 years of age reported a history of injection drug use, the strongest risk factor for HCV infection. Of all persons reporting such a history, 83.3% had not used injection drugs for at least 1 year before the survey. Other significant risk factors included 20 or more lifetime sex partners and blood transfusion before 1992. Abnormal serum ALT levels were found in 58.7% of HCV RNA-positive persons. Three characteristics (abnormal serum ALT level, any history of injection drug use, and history of blood transfusion before 1992) identified 85.1% of HCV RNA-positive participants between 20 and 59 years of age. |
4 |
| 2. Davis GL, Alter MJ, El-Serag H, Poynard T, Jennings LW. Aging of hepatitis C virus (HCV)-infected persons in the United States: a multiple cohort model of HCV prevalence and disease progression. Gastroenterology. 2010;138(2):513-521, 521 e511-516. |
Review/Other-Dx |
N/A |
To project the future prevalence of CH-C and its complications. |
Prevalence of CH-C peaked in 2001 at 3.6 million. Fibrosis progression was inversely related to age at infection, so cirrhosis and its complications were most common after the age of 60 years, regardless of when infection occurred. The proportion of CH-C with cirrhosis is projected to reach 25% in 2010 and 45% in 2030, although the total number with cirrhosis will peak at 1.0 million (30.5% higher than the current level) in 2020 and then decline. Hepatic decompensation and liver cancer will continue to increase for another 10 to 13 years. Treatment of all infected patients in 2010 could reduce risk of cirrhosis, decompensation, cancer, and liver-related deaths by 16%, 42%, 31%, and 36% by 2020, given current response rates to antiviral therapy. |
4 |
| 3. Morgan RL, Baack B, Smith BD, Yartel A, Pitasi M, Falck-Ytter Y. Eradication of hepatitis C virus infection and the development of hepatocellular carcinoma: a meta-analysis of observational studies. Ann Intern Med. 2013;158(5 Pt 1):329-337. |
Meta-analysis |
30 studies |
To systematically review observational studies to determine the association between response to HCV therapy and development of HCC among persons at any stage of fibrosis and those with advanced liver disease. |
Thirty studies fulfilled the inclusion criteria, and 18 provided adjusted effect estimates that were used to calculate pooled relative risks. Among HCV-infected persons, SVR was associated with reduced risk for HCC (relative risk for all persons, 0.24 [95% CI, 0.18 to 0.31], moderate-quality evidence; advanced liver disease hazard ratio, 0.23 [CI, 0.16 to 0.35], moderate-quality evidence). |
Good |
| 4. Asrani SK, Devarbhavi H, Eaton J, Kamath PS. Burden of liver diseases in the world. J Hepatol 2019;70:151-71. |
Review/Other-Dx |
N/A |
To describe the global burden of liver diseases. |
No results stated in abstract. |
4 |
| 5. Asrani SK, Larson JJ, Yawn B, Therneau TM, Kim WR. Underestimation of liver-related mortality in the United States. Gastroenterology. 2013;145(2):375-382 e371-372. |
Review/Other-Dx |
261 patients |
To update data on liver mortality in the United States. |
The Rochester Epidemiology Project database contained information on 261 liver-related deaths, with an age- and sex-adjusted death rate of 27.0/100,000 persons (95% confidence interval: 23.7-30.3). Of these, only 71 deaths (27.2%) would have been captured by the NCHS definition. Of cases for which viral hepatitis or hepatobiliary cancer was the cause of death, 96.9% and 94.3% had liver-related immediate causes of death, respectively. In analysis of data from the National Death registry (2008), use of the updated definition increased liver mortality by >2-fold (from 11.7 to 25.7 deaths/100,000, respectively). Using NCHS definitions, liver-related deaths decreased from 18.9/100,000 in 1979 to 11.7/100,000 in 2008-a reduction of 38%. However, using the updated estimate, liver-related deaths were essentially unchanged from 1979 (25.8/100,000) to 2008 (25.7/100,000). Mortality burden was systematically underestimated among non-whites and persons of Hispanic ethnicity. |
4 |
| 6. Tapper EB, Parikh ND. Mortality due to cirrhosis and liver cancer in the United States, 1999-2016: observational study. BMJ. 362:k2817, 2018 07 18. |
Review/Other-Dx |
N/A |
To describe liver disease related mortality in the United States during 1999-2016 by age group, sex, race, cause of liver disease, and geographic region. |
From 1999 to 2016 in the US annual deaths from cirrhosis increased by 65%, to 34?174, while annual deaths from hepatocellular carcinoma doubled to 11?073. Only one subgroup-Asians and Pacific Islanders-experienced an improvement in mortality from hepatocellular carcinoma: the death rate decreased by 2.7% (95% confidence interval 2.2% to 3.3%, P<0.001) per year. Annual increases in cirrhosis related mortality were most pronounced for Native Americans (designated as "American Indians" in the census database) (4.0%, 2.2% to 5.7%, P=0.002). The age adjusted death rate due to hepatocellular carcinoma increased annually by 2.1% (1.9% to 2.3%, P<0.001); deaths due to cirrhosis began increasing in 2009 through 2016 by 3.4% (3.1% to 3.8%, P<0.001). During 2009-16 people aged 25-34 years experienced the highest average annual increase in cirrhosis related mortality (10.5%, 8.9% to 12.2%, P<0.001), driven entirely by alcohol related liver disease. During this period, mortality due to peritonitis and sepsis in the setting of cirrhosis increased substantially, with respective annual increases of 6.1% (3.9% to 8.2%) and 7.1% (6.1% to 8.4%). Only one state, Maryland, showed improvements in mortality (-1.2%, -1.7% to -0.7% per year), while many, concentrated in the south and west, observed disproportionate annual increases: Kentucky 6.8% (5.1% to 8.5%), New Mexico 6.0% (4.1% to 7.9%), Arkansas 5.7% (3.9% to 7.6%), Indiana 5.0% (3.8% to 6.1%), and Alabama 5.0% (3.2% to 6.8%). No state showed improvements in hepatocellular carcinoma related mortality, while Arizona (5.1%, 3.7% to 6.5%) and Kansas (4.3%, 2.8% to 5.8%) experienced the most severe annual increases. |
4 |
| 7. Regev A, Berho M, Jeffers LJ, et al. Sampling error and intraobserver variation in liver biopsy in patients with chronic HCV infection. Am J Gastroenterol. 2002;97(10):2614-2618. |
Observational-Dx |
124 patients |
To determine the rate and extent of sampling error in patients with chronic hepatitis C virus infection, and to assess the intraobserver variation with the commonly used scoring system proposed by Scheuer and modified by Batts and Ludwig. |
Thirty of 124 patients (24.2%) had a difference of at least one grade, and 41 of 124 patients (33.1%) had a difference of at least one stage between the right and left lobes. In 18 patients (14.5%), interpretation of cirrhosis was given in one lobe, whereas stage 3 fibrosis was given in the other. A difference of two stages or two grades was found in only three (2.4%) and two (1.6%) patients, respectively. Of the 50 samples that were examined twice, the grading by each pathologist on the second examination differed from the first examination in 0% and 4%, and the staging differed in 6% and 10%, respectively. All observed variations were of one grade or one stage. |
2 |
| 8. Rockey DC, Caldwell SH, Goodman ZD, Nelson RC, Smith AD. Liver biopsy. Hepatology. 2009;49(3):1017-1044. |
Review/Other-Dx |
N/A |
To summarize the current practice of liver biopsy and make recommendations about its performance. |
No results stated in abstract. |
4 |
| 9. Parkes J, Guha IN, Roderick P, Rosenberg W. Performance of serum marker panels for liver fibrosis in chronic hepatitis C. J Hepatol. 2006;44(3):462-474. |
Meta-analysis |
14 studies |
To assess the performance of panels of serum markers of hepatic fibrosis in CHC, incorporating analyses placing markers in a clinical context. |
14 studies were included with 10 different panels. Median AUC in validation populations was 0.77 and training populations 0.81. Likelihood ratios (LR) ranged from -LR 0.1 to 0.9, + LR 1.2 to 33.1, diagnostic odds ratios (DOR) were 9.0 (median) with a range of 5 to 27- mostly below values of robust tests. Tests perform with either high sensitivity with low specificity or vice versa. Cut-off levels that gave clinically relevant predictive values for the presence/absence of significant fibrosis were applicable to 35% of the population. |
M |
| 10. Marrero JA, Kulik LM, Sirlin CB, et al. Diagnosis, Staging, and Management of Hepatocellular Carcinoma: 2018 Practice Guidance by the American Association for the Study of Liver Diseases. Hepatology. 68(2):723-750, 2018 Aug. |
Review/Other-Dx |
N/A |
To provide a data-supported approach to the diagnosis, staging, and treatment of patients diagnosed with hepatocellular carcinoma (HCC). |
No abstract available. |
4 |
| 11. Heimbach JK, Kulik LM, Finn RS, et al. AASLD guidelines for the treatment of hepatocellular carcinoma. Hepatology. 67(1):358-380, 2018 01. |
Review/Other-Dx |
N/A |
To present official recommendations of the American Association for the Study of Liver Diseases (AASLD) on the surveillance, diagnosis, and treatment of hepatocellular carcinoma (HCC) occurring in the setting of adults with cirrhosis. |
No abstract available. |
4 |
| 12. Bruix J, Sherman M. Management of hepatocellular carcinoma: an update. Hepatology. 2011;53(3):1020-1022. |
Review/Other-Tx |
N/A |
To provide an update of the AASLD practice guidelines on the management of HCC which published in 2005. |
n/a |
4 |
| 13. Omata M, Cheng AL, Kokudo N, et al. Asia-Pacific clinical practice guidelines on the management of hepatocellular carcinoma: a 2017 update. [Review]. Hepatol Int. 11(4):317-370, 2017 Jul. |
Review/Other-Dx |
N/A |
To provide guidelines that recommend evidence-based management of HCC and that are considered suitable for universal use in the Asia–Pacific region, which has a diversity of medical environments. |
No results stated in abstract. |
4 |
| 14. Jang HJ, Kim TK, Wilson SR. Small nodules (1-2 cm) in liver cirrhosis: characterization with contrast-enhanced ultrasound. Eur J Radiol. 2009; 72(3):418-424. |
Observational-Dx |
59 patients |
To determine the diagnostic efficacy of arterial phase CEUS for characterizing small hepatic nodules (1-2 cm) in patients with high-risk for HCC. |
At of the time of CEUS, the 59 nodules were diagnosed as HCC in 26 and benign lesions in 33, including 20 regenerative nodules/DN, 11 hemangiomas, and 2 focal fat sparing. All 26 nodules with arterial phase hypervascularity without hemangioma-like features were HCC. However, CEUS misdiagnosed HCC as regenerative nodules/DN in 4 cases with arterial iso- (n=3) or hypovascularity (n=1). CEUS correctly diagnosed all 11 hemangiomas. The sensitivity, specificity, and accuracy of CEUS for diagnosing HCC were 86.7%, 100%, and 93.2%. |
3 |
| 15. Di Lelio A, Cestari C, Lomazzi A, Beretta L. Cirrhosis: diagnosis with sonographic study of the liver surface. Radiology. 1989;172(2):389-392. |
Observational-Dx |
50 healthy subjects, 75 patients with suspected diffuse chronic liver disease, and 225 patients with cancer. |
To find an objective sonographic sign of cirrhosis. |
A diagnosis of cirrhosis was made with sonography when surface irregularities were observed that were comparable to the anatomic abnormalities of a cirrhotic liver surface. An examination of the liver surface gave the best diagnostic rate for cirrhosis (88%). There were seven false-negative results, but in five of them no surface nodularity could be seen at laparoscopy, and the diagnosis was made only on the basis of histologic studies; there was one false-positive result. This study indicated that ultrasonography might be a reliable method to follow up patients with chronic liver disease that may progress to cirrhosis. |
3 |
| 16. Simonovsky V. The diagnosis of cirrhosis by high resolution ultrasound of the liver surface. Br J Radiol. 1999;72(853):29-34. |
Observational-Dx |
91 patients |
To assess the clinical usefulness of high resolution ultrasound (US) analysis of the liver surface for the diagnosis of cirrhosis. |
On 91 diagnostic studies, the sensitivity of US for cirrhosis was 91.1%, the specificity 93.5% and the accuracy 92.3%. Positive and negative predictive values were 93.2% and 91.5%, respectively. Provided non-diagnostic cases were considered as technically satisfactory studies and included as true-positive and false-positive cases, this would slightly increase the sensitivity but decrease specificity and accuracy to 91.8%, 84.3%, and 88.0%, respectively. |
3 |
| 17. Torres WE, Whitmire LF, Gedgaudas-McClees K, Bernardino ME. Computed tomography of hepatic morphologic changes in cirrhosis of the liver. J Comput Assist Tomogr. 1986;10(1):47-50. |
Observational-Dx |
75 cirrhotic patients; 50 normal patients |
To quantitate hepatic morphologic changes specific for cirrhosis. |
The mean percentage of the total liver volume occupied by the right hepatic lobe decreased by 15.2% (p less than 0.0001) and the mean percentage of the total liver volume occupied by the medial segment of the left lobe decreased in volume by 10.9% (p less than 0.09) when compared with normals. Concomitantly, the mean percentage of the total liver volume occupied by the caudate lobe increased by 192% (p less than 0.0001) and the mean percentage of the total liver volume occupied by the lateral segment of the left lobe increased by 55.6% (p less than 0.0001). This increase in the volume of the lateral segment of the left lobe and decrease in the volume of the medial segment of the left lobe have not been described previously. |
3 |
| 18. Ito K, Mitchell DG, Kim MJ, Awaya H, Koike S, Matsunaga N. Right posterior hepatic notch sign: a simple diagnostic MR finding of cirrhosis. J Magn Reson Imaging. 2003;18(5):561-566. |
Observational-Dx |
202 patients with pathologically proved cirrhosis. 128 without clinical evidence of chronic liver diseases. |
To determine the frequency of occurrence of the right posterior hepatic notch sign at MR imaging in patients with cirrhosis, and to assess its diagnostic capability of this sign as a simple diagnostic MR finding of cirrhosis. |
The right posterior hepatic notch sign was observed in 145 of the 202 patients in the cirrhosis group, while this sign was seen in only two of the 128 patients in the control group (P < 0.0001). The sensitivity, specificity, and accuracy of this sign for the MR diagnosis of cirrhosis were 72%, 98%, and 82%, respectively. When the presence of either the expanded gallbladder fossa sign or the right posterior hepatic notch sign was considered for the MR diagnosis of cirrhosis, the sensitivity and accuracy increased to 86% and 89%, respectively. |
2 |
| 19. Pickhardt PJ, Malecki K, Kloke J, Lubner MG. Accuracy of Liver Surface Nodularity Quantification on MDCT as a Noninvasive Biomarker for Staging Hepatic Fibrosis. AJR. American Journal of Roentgenology. 207(6):1194-1199, 2016 Dec. |
Observational-Dx |
367 Patients |
To investigate objective semiautomated measurement of liver surface nodularity on MDCT for prediction of underlying hepatic fibrosis (stages F0-F4). |
The study participants were 367 patients (191 men, 176 women; mean age, 51.1 years) divided into a healthy (F0) control group (n = 118) and patients with fibrosis in stages F1 (n = 47), F2 (n = 38), F3 (n = 67), and F4, which constituted cirrhosis (n = 97). MDCT-based liver surface nodularity scores increased with stage of fibrosis: F0, 2.01 ± 0.28; F1, 2.34 ± 0.39; F2, 2.37 ± 0.39; F3, 2.88 ± 0.68; and F4, 4.11 ± 0.95. For discriminating significant fibrosis (= F2), advanced fibrosis (= F3), and cirrhosis (= F4), the ROC AUCs were 0.902, 0.932, and 0.959, respectively. The sensitivity and specificity for significant fibrosis (= F2; liver surface nodularity threshold, 2.38) were 80.2% and 80.0%, for advanced fibrosis (= F3; liver surface nodularity threshold, 2.53) were 89.0% and 84.2%, and for cirrhosis (= F4; liver surface nodularity threshold, 2.81) were 97.9% and 84.8%. |
3 |
| 20. Smith AD, Zand KA, Florez E, et al. Liver Surface Nodularity Score Allows Prediction of Cirrhosis Decompensation and Death. Radiology. 283(3):711-722, 2017 06. |
Observational-Dx |
830 Patients |
To determine whether use of the liver surface nodularity (LSN) score, a quantitative biomarker derived from routine computed tomographic (CT) images, allows prediction of cirrhosis decompensation and death. |
In patients with compensated cirrhosis, 40% (129 of 326) experienced decompensation during a median follow-up period of 4.22 years. After adjustment for competing risks including MELD score, LSN score (hazard ratio, 1.38; 95% confidence interval: 1.06, 1.79) was found to be independently predictive of hepatic decompensation. Median times to decompensation of patients at high (1.76 years, n = 48), intermediate (3.79 years, n = 126), and low (6.14 years, n = 152) risk of hepatic decompensation were significantly different (P < .001). Among the full cohort with compensated or decompensated cirrhosis, 61% (504 of 830) died during the median follow-up period of 2.26 years. After adjustment for competing risks, LSN score (hazard ratio, 1.22; 95% confidence interval: 1.11, 1.33) and MELD score (hazard ratio, 1.08; 95% confidence interval: 1.06, 1.11) were found to be independent predictors of death. Median times to death of patients at high (0.94 years, n = 315), intermediate (2.79 years, n = 312), and low (4.69 years, n = 203) risk were significantly different (P < .001). |
4 |
| 21. Zissen MH, Wang ZJ, Yee J, Aslam R, Monto A, Yeh BM. Contrast-enhanced CT quantification of the hepatic fractional extracellular space: correlation with diffuse liver disease severity. AJR Am J Roentgenol. 201(6):1204-10, 2013 Dec. |
Observational-Dx |
106 Patients |
To determine whether contrast-enhanced CT quantification of the hepatic fractional extracellular space (ECS) correlates with the severity of diffuse liver disease. |
The mean Model of End-Stage Liver Disease (MELD) score was higher in patients with than in those without cirrhosis (14.3 ± 7.3 versus 7.20 ± 2.4, p < 0.0001). The mean fractional ECS was significantly greater in patients with cirrhosis than in those without cirrhosis (41.0% ± 9.0% versus 23.8% ± 6.3%, p < 0.0001). The fractional ECS correlated with the MELD score (r = 0.572, p < 0.0001) and was predictive of cirrhosis with an area under the receiver operating characteristic curve of 0.953 (p < 0.0001). The sensitivity and specificity of an expanded fractional ECS greater than 30% for the prediction of cirrhosis were 92% and 83%. Multivariate linear regression revealed that the fractional ECS is complementary to the MELD score as a predictor of cirrhosis (p < 0.0001). |
4 |
| 22. Varenika V, Fu Y, Maher JJ, et al. Hepatic fibrosis: evaluation with semiquantitative contrast-enhanced CT. Radiology. 266(1):151-8, 2013 Jan. |
Observational-Dx |
21 rats |
To evaluate the feasibility of using contrast material-enhanced computed tomographic (CT) measurements of hepatic fractional extracellular space (fECS) and macromolecular contrast material (MMCM) uptake to measure severity of liver fibrosis. |
Ishak fibrosis scores ranged from a baseline of 0 in untreated animals to a maximum of 5. Histopathologic liver fibrosis area increased from 0.46% to 3.5% over the same interval. Strong correlations were seen between conventional contrast-enhanced CT measurements of fECS and both the Ishak fibrosis scores (R(2) = 0.751, P < .001) and the fibrosis area (R(2) = 0.801, P < .001). Strong negative correlations were observed between uptake of MMCM in the liver and Ishak fibrosis scores (R(2) = 0.827, P < .001), as well as between uptake of MMCM in the liver and fibrosis area (R(2) = 0.643, P = .001). Multivariate linear regression analysis showed a trend toward independence for fECS and MMCM uptake in the prediction of Ishak fibrosis scores, with an R(2) value of 0.86 (P = .081 and P = .033, respectively). |
3 |
| 23. Bonekamp D, Bonekamp S, Geiger B, Kamel IR. An elevated arterial enhancement fraction is associated with clinical and imaging indices of liver fibrosis and cirrhosis. J Comput Assist Tomogr. 2012;36(6):681-689. |
Observational-Dx |
65 patients |
To determine whether arterial enhancement fraction (AEF) is associated with the degree of liver fibrosis and cirrhosis in patients with chronic liver disease |
Mean AEF was higher in patients with liver disease compared with those without liver disease. Mean AEF differed significantly between patients with normal liver or mild fibrosis (category 1), moderate to severe fibrosis (category 2), and cirrhosis (category 3). Receiver operating characteristic curve analysis determined an area under the curve of 0.79/0.78, with an optimal cutoff for mean AEF of 9.2/16.8, for differentiating between category 2 or higher/category 3 disease. |
3 |
| 24. Bonekamp S, Kamel I, Solga S, Clark J. Can imaging modalities diagnose and stage hepatic fibrosis and cirrhosis accurately? J Hepatol. 2009;50(1):17-35. |
Review/Other-Dx |
N/A |
To assess performance and promise of radiologic modalities and techniques as alternative, noninvasive assessment of hepatic fibrosis. |
A systematic review revealed accurate staging of fibrosis or diagnosis of mild fibrosis was often not achievable. Ultrasonography is the most common modality used in the diagnosis and staging of hepatic fibrosis. Elastographic measurements, either ultrasonography-based or magnetic resonance-based, and magnetic resonance diffusion weighted imaging, show the most promise for accurate staging of hepatic fibrosis. Most currently available imaging techniques can detect cirrhosis or significant fibrosis reasonably accurately. However, to date only magnetic resonance elastography has been able to stage fibrosis or diagnose mild disease. |
4 |
| 25. Singh S, Venkatesh SK, Wang Z, et al. Diagnostic performance of magnetic resonance elastography in staging liver fibrosis: a systematic review and meta-analysis of individual participant data. [Review]. Clinical Gastroenterology & Hepatology. 13(3):440-451.e6, 2015 Mar. |
Review/Other-Dx |
12 Studies including 697 patients |
To assess the diagnostic accuracy of MRE for staging liver fibrosis in patients with chronic liver diseases (CLD). |
We analyzed data from 12 retrospective studies, comprising 697 patients (mean age, 55 +/- 13 y; 59.4% male; mean BMI, 26.9 +/- 6.7 kg/m(2); 92.1% with <1 year interval between MRE and biopsy; and 47.1% with hepatitis C). Overall, 19.5%, 19.4%, 15.5%, 15.9%, and 29.7% patients had stage 0, 1, 2, 3, and 4 fibrosis, respectively. The mean area under the receiver-operating curve values (and 95% confidence intervals) for the diagnosis of any (>/=stage 1), significant (>/=stage 2), advanced fibrosis (>/=stage 3), and cirrhosis, were as follows: 0.84 (0.76-0.92), 0.88 (0.84-0.91), 0.93 (0.90-0.95), and 0.92 (0.90-0.94), respectively. A similar diagnostic performance was observed in stratified analysis based on sex, obesity, and etiology of CLD. The overall rate of failure of MRE was 4.3% |
4 |
| 26. Chou CT, Chen RC, Wu WP, Lin PY, Chen YL. Prospective Comparison of the Diagnostic Performance of Magnetic Resonance Elastography with Acoustic Radiation Force Impulse Elastography for Pre-operative Staging of Hepatic Fibrosis in Patients with Hepatocellular Carcinoma. Ultrasound Med Biol. 43(12):2783-2790, 2017 Dec. |
Observational-Dx |
77 Patients |
To compare the diagnostic accuracy of magnetic resonance (MR) elastography with that of acoustic radiation force impulse (ARFI) elastography for pre-operative staging of hepatic fibrosis in patients with hepatocellular carcinoma. |
Correlations between MRE and ARFI elastography findings and histologic findings were determined by receiver operating characteristic (ROC) analysis. Correlation of MRE was excellent and correlation of ARFI elastography was good with fibrosis stage. MRE had better diagnostic performance than ARFI elastography in estimating substantial fibrosis (F2), severe fibrosis (F3) and cirrhosis (F4). The optimal cutoff value and the area under the ROC curve (AUROC) were determined using ROC curve analysis. The highest Youden index was used as a criterion for selecting the optimal cutoff value. ROC analysis revealed that MRE discriminated advanced stages of fibrosis (F?=?2) well in patients with hepatocellular carcinoma at a cutoff value of 3.0?kPa with an AUROC value of 0.93, and ARFI elastography did so at a cutoff value of 1.77?m/s with an AUROC value of 0.81 for predicting advanced stages of fibrosis (F?=?2). |
3 |
| 27. Venkatesh SK, Yin M, Ehman RL. Magnetic resonance elastography of liver: technique, analysis, and clinical applications. [Review]. Journal of Magnetic Resonance Imaging. 37(3):544-55, 2013 Mar. |
Review/Other-Dx |
N/A |
To describe the basic principles, technique of performing a liver MR elastography (MRE), analysis and calculation of stiffness, clinical applications, limitations, and potential future applications. |
No results stated in abstract. |
4 |
| 28. Martin DR, Lauenstein T, Kalb B, et al. Liver MRI and histological correlates in chronic liver disease on multiphase gadolinium-enhanced 3D gradient echo imaging. J Magn Reson Imaging. 2012;36(2):422-429. |
Observational-Dx |
75 patients |
To evaluate intrinsic hepatic enhancement patterns on multiphase, gadolinium-enhanced, fat-suppressed, 3D T1-weighted, gradient echo magnetic resonance imaging (MRI) as a quantitative correlate for severity of pathological changes in chronic liver disease (CLD). |
MRI histology correlation was high for delayed-phase MRI versus fibrosis stage (95% confidence interval [CI] 0.941 < r < 0.976, P = 5 x 10(-7)), but lower for all other comparisons (delayed-phase vs. inflammation and arterial-phase vs. inflammation or fibrosis all showed a CI no greater than 0.64). Paired testing between delayed-phase MRI score and histology fibrosis staging incremental levels was significant (from P < 10(-2) to P < 10(-5)). |
2 |
| 29. Wang QB, Zhu H, Liu HL, Zhang B. Performance of magnetic resonance elastography and diffusion-weighted imaging for the staging of hepatic fibrosis: A meta-analysis. Hepatology. 2012;56(1):239-247. |
Meta-analysis |
14 studies |
To assess and compare the accuracies of magnetic resonance elastography (MRE) and diffusion-weighted imaging (DWI) for the staging of hepatic fibrosis. |
With MRE, the sensitivity, specificity, DOR, PLR, NLR, and area under sROC curve (with 95% CIs) for staging F0 approximately F1 versus F2 approximately F4 and F0 approximately F2 versus F3 approximately F4 were 0.94 (0.81-0.98), 0.95 (0.87-0.98), 20 (7-57), 0.06 (0.02-0.22), 317 (55-1,796), 0.98 (0.97-0.99) and 0.92 (0.85-0.96), 0.96 (0.91-0.98), 21 (10-45), 0.08 (0.04-0.16), 251 (103-609), and 0.98 (0.96-0.99), respectively; and with DWI, these values were 0.77 (0.71-0.82), 0.78 (0.69-0.85), 3 (2-5), 0.30 (0.22-0.40), 12 (6-21), 0.83 (0.79-0.86) and 0.72 (0.60-0.81), 0.84 (0.77-0.89), 5 (3-7), 0.34 (0.23-0.50), 13 (6-29), and 0.86 (0.83-0.89), respectively. A z test demonstrated that MRE had a significantly higher accuracy than DWI in those indicators (P < 0.05). |
Good |
| 30. Chen BB, Hsu CY, Yu CW, et al. Dynamic contrast-enhanced magnetic resonance imaging with Gd-EOB-DTPA for the evaluation of liver fibrosis in chronic hepatitis patients. Eur Radiol. 22(1):171-80, 2012 Jan. |
Observational-Dx |
79 patients (21 in the healthy group and 58 in the hepatitis group) |
To develop a non-invasive MRI method for evaluation of liver fibrosis, with histological analysis as the reference standard. |
Slope and AUC were two best perfusion parameters to predict the severity of liver fibrosis (>F2 vs. <==F2). Four significantly different variables were found between non-fibrotic versus mild-fibrotic subgroups: F (a), ART, Slope, and AUC; the best predictor for mild fibrosis was F (a) (AUROC:0.701). |
2 |
| 31. Choi YR, Lee JM, Yoon JH, Han JK, Choi BI. Comparison of magnetic resonance elastography and gadoxetate disodium-enhanced magnetic resonance imaging for the evaluation of hepatic fibrosis. Invest Radiol. 2013;48(8):607-613. |
Observational-Dx |
168 patients |
To compare the diagnostic performance of magnetic resonance elastography (MRE) and gadoxetate disodium-enhanced magnetic resonance imaging (MRI) in the staging of hepatic fibrosis (HF) in patients with liver diseases. Note: Contrast was administered. |
The liver stiffness values measured on MRE (r = 0.802; P < 0.0001) were more strongly correlated with the HF stage than with the contrast enhanced index or CEI (r = -0.378; P < 0.0001). The areas under the receiver operating characteristic curve values of the liver stiffness values were significantly larger than those of CEI were for discriminating all stages of HF (P < 0.001 for >/= F1, >/= F2, >/= F3, and >/= F4). Magnetic resonance elastography showed higher sensitivity and specificity for predicting HF >/= F1 (91% and 87%), >/= F2 (87% and 91%), >/= F3 (80% and 89%), and F4 (81% and 85%) compared with CEI (46% and 85%, 46% and 82%, 63% and 68%, and 76% and 65%, respectively). |
2 |
| 32. Watanabe H, Kanematsu M, Goshima S, et al. Staging hepatic fibrosis: comparison of gadoxetate disodium-enhanced and diffusion-weighted MR imaging--preliminary observations. Radiology. 2011;259(1):142-150. |
Observational-Dx |
114 patients
Note: Contrast enhanced magnetic resonance (MR) |
To evaluate the utility of hepatocyte-phase gadoxetate disodium-enhanced magnetic resonance (MR) imaging in staging hepatic fibrosis and to compare it with diffusion-weighted imaging. |
Among the MR, hematologic, and clinical parameters, contrast enhancement index was most strongly correlated with fibrosis stage (r = -0.79, P < .001). Multiple regression analysis showed that the contrast enhancement index, ADC, and prothrombin time were significantly correlated (r(2) = 0.66, P < .05) with fibrosis stage and that the contrast enhancement index and serum total bilirubin level were weakly correlated (r(2) = 0.24, P < .05) with the necroinflammatory activity grade. |
2 |
| 33. Colli A, Colucci A, Paggi S, et al. Accuracy of a predictive model for severe hepatic fibrosis or cirrhosis in chronic hepatitis C. World J Gastroenterol. 2005;11(46):7318-7322. |
Observational-Dx |
176 patients |
To assess the accuracy of a model in diagnosing severe fibrosis/cirrhosis in chronic hepatitis C virus (HCV) infection. |
Severe fibrosis/cirrhosis was found in 67 patients (38%). The model discriminated patients in three comparable groups: 34% with a very high (>90%) or low (<10%) probability of severe fibrosis, 33% with a probability ranging from 75% to 90%, and 33% with an uncertain diagnosis (i.e., a probability ranging from 10% to 74%). The observed frequency of severe fibrosis/cirrhosis was within the predefined ranges. |
2 |
| 34. Tchelepi H, Ralls PW, Radin R, Grant E. Sonography of diffuse liver disease. J Ultrasound Med. 2002;21(9):1023-1032; quiz 1033-1024. |
Review/Other-Dx |
N/A |
To discuss the uses and limitations of sonography in evaluating parenchymal liver disease. |
Sonography is of limited usefulness in acute hepatitis. Increased parenchymal echogenicity is a reliable criterion for diagnosing fatty liver. Cirrhosis can be diagnosed in the correct clinical setting when the following are present: a nodular liver surface, decreased right lobe-caudate lobe ratio, and indirect evidence of portal hypertension (collateral vessels and splenomegaly). |
4 |
| 35. Kim G, Shim KY, Baik SK. Diagnostic Accuracy of Hepatic Vein Arrival Time Performed with Contrast-Enhanced Ultrasonography for Cirrhosis: A Systematic Review and Meta-Analysis. [Review]. Gut and liver. 11(1):93-101, 2017 Jan 15. |
Review/Other-Dx |
844 Patients |
To identify reports in the literature regarding the diagnostic accuracy of hepatic vein arrival time (HVAT) measured by contrast-enhanced ultrasonography (CEUS) to assess hepatic fibrosis in cirrhosis. |
A total of 12 studies including 844 patients with chronic liver disease met our inclusion criteria. The overall summary sensitivity, specificity, positive likelihood ratio, and negative likelihood ratio of the HVAT measured by CEUS for the detection of cirrhosis compared to LB were 0.83 (95% confidence interval [CI], 0.77 to 0.89), 0.75 (95% CI, 0.69 to 0.79), 3.45 (95% CI, 1.60 to 7.43), and 0.28 (95% CI, 0.10 to 0.74), respectively. The summary diagnostic odds ratio (random effects model) was 15.23 (95% CI, 3.07 to 75.47), the summary receiver operator characteristics area under the curve was 0.74 (standard error [SE]=0.14), and the index Q was 0.69 (SE=0.11). |
4 |
| 36. Nasr P, Hilliges A, Thorelius L, Kechagias S, Ekstedt M. Contrast-enhanced ultrasonography could be a non-invasive method for differentiating none or mild from severe fibrosis in patients with biopsy proven non-alcoholic fatty liver disease. Scand J Gastroenterol. 51(9):1126-32, 2016 Sep. |
Observational-Dx |
58 Patients |
To determine whether contrast-enhanced ultrasonography (CEUS) with transit time measurements could be a non-invasive alternative for differentiating none or mild from severe fibrosis in NAFLD patients. Various serum markers and clinical variables were also evaluated. |
The hepatic vein arrival time (HV) was shorter in patients with severe fibrosis (25.9?±?4.8 vs 29.5?±?4.7?s, p?=?0.023), and the difference between the hepatic and portal vein (?HV-PV) was shorter (2.3?±?2.8 vs 6.4?±?2.8?s, p?<?0.0001) while the difference in arrival time between the portal vein and hepatic artery (?PV-HA) arrival time was significantly longer (6.0?±?2.2 vs 3.6?±?1.6?s, p?<?0.0001). The area under receiver operating characteristics curve values for HV, ?HV-PV and ?PV-HA to separate none or mild from severe fibrosis was 0.71, 0.83 and 0.84, respectively. The corresponding figures for GUCI, APRI, NAFLD fibrosis score, FIB-4 and BARD score were 0.93, 0.92, 0.86, 0.90 and 0.77, respectively. |
3 |
| 37. Arena U, Vizzutti F, Corti G, et al. Acute viral hepatitis increases liver stiffness values measured by transient elastography. Hepatology. 2008;47(2):380-384. |
Observational-Dx |
18 patients |
To definitively assess the influence of necro-inflammation on liver stiffness measurement (LSM). |
In all patients, the degree of liver stiffness at the time of the peak increase in aminotransferases exceeded the cutoff values proposed for the prediction of significant fibrosis or cirrhosis. A progressive significant reduction in liver stiffness values was observed (P<0.0001) in the follow-up period in parallel with the reduction of aminotransferase levels (P < 0.0001). Moreover, a statistically significant, positive correlation between aminotransferases and liver stiffness measurement (LSM) at the onset of acute viral hepatitis was found (r = 0.53, P = 0.02 and r = 0.51, P = 0.03 for alanine aminotransferase and aspartate aminotransferase, respectively). (r 0.53, P 0.02 and |
2 |
| 38. Millonig G, Reimann FM, Friedrich S, et al. Extrahepatic cholestasis increases liver stiffness (FibroScan) irrespective of fibrosis. Hepatology. 2008;48(5):1718-1723. |
Observational-Dx |
15 patients presenting with extrahepatic cholestasis |
To determine if the measurement of liver stiffness by FS is altered in patients with extrahepatic cholestasis. |
Initially elevated liver stiffness decreased in 13 of 15 patients after intervention, in 10 of them markedly. In three patients, liver stiffness was elevated to a degree that suggested advanced liver cirrhosis (mean, 15.2 kPa). Successful drainage led to a drop of bilirubin by 2.8 to 9.8 mg/dL whereas liver stiffness almost normalized (mean, 7.1 kPa). In all patients with successful biliary drainage, the decrease of liver stiffness highly correlated with decreasing bilirubin (Spearman’s p = 0.67, P < 0.05) with a mean decrease of liver stiffness of 1.2 +/- 0.56 kPa per 1 g/dL bilirubin. Two patients, in whom liver stiffness did not decrease despite successful biliary drainage, had advanced liver cirrhosis and multiple liver metastases, respectively. |
3 |
| 39. Hu X, Qiu L, Liu D, Qian L. Acoustic Radiation Force Impulse (ARFI) Elastography for non-invasive evaluation of hepatic fibrosis in chronic hepatitis B and C patients: a systematic review and meta-analysis. [Review]. Medical Ultrasonography. 19(1):23-31, 2017 Jan 31. |
Meta-analysis |
21 articles
2,691 patients |
To assess the effect of Acoustic Radiation Force Impulse (ARFI) elastography in the diagnosis of liver fibrosis in chronic hepatitis B and C patients through Meta-analysis. |
21 articles with 2,691 patients were included. The compositeSe=0.79 (95% CI: 0.76-0.83) and Sp=0.86 (95% CI: 0.85-0.88). ARFI elastography showed a better ability to evaluate higherstage liver fibrosis and liver cirrhosis (F=3 and F=4, respectively). For F=3, Se=0.84 (95% CI: 0.80-0.88, I2=61.37), Sp=0.90 (95% CI: 0.86-0.92, I2=65.10), and AUROC=0.94 (95% CI: 0.91-0.95). Se and Sp and AUROC of F=4 were 0.86 (95% CI: 0.80-0.91, I2=70.67), 0.84 (95% CI: 0.80-0.88, I2=78.94) and 0.91 (95% CI: 0.89-0.94), respectively. Besides, the combined RFI values indicate that CHC patients had higher ARFI values especially in the F3 stage (1.87 [95% CI: 1.67-2.06] and 2.31[95% CI: 2.09-2.52] for CHB and CHC, respectively). |
Good |
| 40. Kawanaka H, Kinjo N, Anegawa G, et al. Abnormality of the hepatic vein waveforms in cirrhotic patients with portal hypertension and its prognostic implications. J Gastroenterol Hepatol. 2008;23(7 Pt 2):e129-136. |
Observational-Dx |
103 patients |
To investigate the prognostic significance of changes in the Doppler hepatic vein (HV) waveforms in cirrhotic patients with portal hypertension and the mechanisms of these changes. |
Type I was observed in 34, type II in 40, type III in 23, and type IV in six patients. The 5-year survival rates were 90%, 89%, 41%, and 0% in type I, II, III, and IV, respectively. Five variables including the Child-Pugh score, albumin, bilirubin, ascites, and HV waveform significantly correlated with the survival in a univariate analysis. A multivariate analysis only identified the HV waveform (type III and IV) to be an independent prognostic value. Even in Child-Pugh class B patients, the 5-year survival rate for type III or IV was as poor as 26% in comparison to 92% for type I or II. In contrast, in Child-Pugh class C patients, the 5-year survival rate for type I or II was as good as 63% in comparison to 25% for type III or IV. Furthermore, the changes in HV waveforms correlated with the extent of hepatic fibrosis, the increase in portal perfusion per liver volume, or the decrease in portal vascular resistance. |
2 |
| 41. Oguzkurt L, Yildirim T, Torun D, Tercan F, Kizilkilic O, Niron EA. Hepatic vein Doppler waveform in patients with diffuse fatty infiltration of the liver. Eur J Radiol. 2005;54(2):253-257. |
Observational-Dx |
40 patients with diffuse FIL and 50 normal healthy adults |
To determine the incidence of abnormal hepatic vein Doppler waveform in patients with diffuse fatty infiltration of the liver (FIL). |
Seventeen of the 40 patients (43%) with FIL had an abnormal HV Doppler waveform, whereas only one of the 50 (2%) healthy subjects had an abnormal waveform. The difference in the distribution of normal Doppler waveform pattern between the patients and the control group was significant (P < 0.001). No differences were found in the behaviour of the hepatic vein Doppler waveform in relation to the different etiologic factors for FIL (P > 0.05). There was not any correlation between the degree of fat infiltration and the hepatic vein waveform pattern (P = 0.60). |
3 |
| 42. Forner A, Reig M, Bruix J. Alpha-fetoprotein for hepatocellular carcinoma diagnosis: the demise of a brilliant star. Gastroenterology. 2009;137(1):26-29. |
Review/Other-Dx |
N/A |
To evaluate usefulness of Alpha-fetoprotein (AFP) in the detection of HCC in the wake of the development of imaging techniques that have allowed the detection of HCC at an early stage. |
No results stated in abstract. |
4 |
| 43. American College of Radiology. ACR Appropriateness Criteria®: Liver Lesion — Initial Characterization. Available at: https://acsearch.acr.org/docs/69472/Narrative/. |
Review/Other-Dx |
N/A |
To assist referring physicians and other providers in making the most appropriate imaging or treatment decision using evidence-based guidelines for the initial characterization of liver lesions. |
No results stated in abstract. |
4 |
| 44. American College of Radiology. Liver Imaging Reporting and Data System (LI-RADS). Available at: http://www.acr.org/quality-safety/resources/LIRADS. |
Review/Other-Dx |
N/A |
LI-RADS® was created to standardize the reporting and data collection of CT and MR imaging for hepatocellular carcinoma (HCC) |
No abstract available. |
4 |
| 45. Luca A, Caruso S, Milazzo M, et al. Multidetector-row computed tomography (MDCT) for the diagnosis of hepatocellular carcinoma in cirrhotic candidates for liver transplantation: prevalence of radiological vascular patterns and histological correlation with liver explants. Eur Radiol. 2010;20(4):898-907. |
Observational-Dx |
125 cirrhotic patients |
To define the prevalence of different multidetector-row computed tomography (MDCT) vascular patterns and their histopathological correlation with liver explants, and to evaluate the accuracy of MDCT for the diagnosis of hepatocellular carcinoma (HCC). |
Positive predictive value (PPV) and likelihood ratio (LR) were 95% and 18.66, respectively, for Hyper-L-Wo; 45% and 0.82 for Hyper-L; and 75% and 3 for Hypo-L of 20 mm or larger. Overall accuracy of MDCT for detection and characterisation of HCC was 89% and 43%, respectively. Sensitivity of MDCT for detection and characterisation was related to the lesion size, ranging from 78% (lesion smaller than 10 mm) to 98% (larger than 20 mm) and from 9% to 64%, respectively. MDCT established the accurate stage of disease in 46% of the patients, underestimated in 52% and overestimated in 2%. |
3 |
| 46. Akai H, Kiryu S, Matsuda I, et al. Detection of hepatocellular carcinoma by Gd-EOB-DTPA-enhanced liver MRI: comparison with triple phase 64 detector row helical CT. Eur J Radiol. 2011;80(2):310-315. |
Observational-Dx |
34 patients
Note: Contrast Enhanced MRI performed as well as CT without and with contrast (multiphasic study). |
To compare the diagnostic performance of Gd-EOB-DTPA-enhanced MRI with that of triple phase 64-MDCT in the detection of hepatocellular carcinoma (HCC). |
Both observers showed higher sensitivity in detecting lesions with MRI compared to CT, however, only the difference between the two imaging techniques for observer 2 was significant (P=0.034). For lesions 1cm or smaller, MRI and CT showed equal sensitivity (both 62.5%) with one observer, and MRI proved superior to CT with the other observer (MRI 75% vs. CT 56.3%), but the latter difference was not significant (P=0.083). The difference in positive and negative predictive value between the two imaging techniques for each observer was not significant (P>0.05). The areas under the ROC curve for each observer were 0.843 and 0.861 for MRI vs. 0.800 and 0.833 for CT and the differences were not significant. Reproducibility was higher using MRI for both observers, but the result was not significant (MRI 32/33 vs. CT 29/33, P=0.083). |
1 |
| 47. Inoue T, Kudo M, Komuta M, et al. Assessment of Gd-EOB-DTPA-enhanced MRI for HCC and dysplastic nodules and comparison of detection sensitivity versus MDCT. J Gastroenterol. 2012;47(9):1036-1047. |
Observational-Dx |
66 patients with 86 nodules |
To evaluate gadolinium ethoxybenzyl diethylenetriamine pentaacetic acid (Gd-EOB-DTPA)-enhanced magnetic resonance imaging (MRI) for the detection of hepatocellular carcinomas (HCCs) and dysplastic nodules (DNs) compared with dynamic multi-detector row computed tomography (MDCT), and to discriminate between HCCs and DNs. |
For hypervascular HCCs, the diagnostic ability of Gd-EOB-DTPA-enhanced MRI was significantly higher than that of MDCT for tumors less than 2 cm (p = 0.048). There was no difference in the detection of hypervascular HCCs between hepatobiliary phase images of Gd-EOB-DTPA-enhanced MRI (43/45: 96%) and dynamic MDCT (40/45: 89%), whereas the detection sensitivity of hypovascular tumors by Gd-EOB-DTPA-enhanced MRI was significantly higher than that by dynamic MDCT (39/41: 95% vs. 25/41: 61%, p = 0.001). EOB enhancement ratios were decreased in parallel with the degree of differentiation in DNs and HCCs, although there was no difference between DNs and hypovascular well-differentiated HCCs. |
2 |
| 48. Yu NC, Chaudhari V, Raman SS, et al. CT and MRI improve detection of hepatocellular carcinoma, compared with ultrasound alone, in patients with cirrhosis. Clin Gastroenterol Hepatol. 2011;9(2):161-167. |
Observational-Dx |
638 patients with cirrhosis |
To analyze the ability of ultrasound (US), computed tomography (CT), and magnetic resonance imaging (MRI) to detect HCC. |
Of the 638 patients, 225 (35%) had HCC, confirmed by pathology analysis of liver explants. In 23 cases, the lesions were infiltrative or extensively multifocal. In the remaining 202 explants (337 numerable, discrete nodules), respective lesion-based sensitivities of US, CT, and MRI were 46%, 65%, and 72% overall and 21%, 40%, and 47% for small (<2 cm) HCC. The sensitivity of US increased with the availability of CT or MRI data (P = .049); sensitivity values were 62% and 85% for lesions 2-4 and >/= 4 cm, respectively. Patient-based specificities of US, CT, and MRI were 96%, 96%, and 87%, respectively. |
3 |
| 49. Khan MA, Combs CS, Brunt EM, et al. Positron emission tomography scanning in the evaluation of hepatocellular carcinoma. J Hepatol 2000;32:792-7. |
Observational-Dx |
20 patients |
To evaluate the role of PET imaging in the diagnosis of hepatocellular carcinoma. |
Of the 20 patients studied, 11 (55%) had positive PET scans (PET score: 3 or 4) while nine (45%) were negative (PET score: 1 or 2). CT scan was positive in 18 patients (90%) and negative in two (10%). PET, however, revealed metastases in three patients that were not seen on CT. On pathological review, well-differentiated and low-grade tumors had lower PET scores. Comparison of the well-differentiated with the moderately- and poorly-differentiated tumors revealed a statistically significant difference. No statistical significance was observed between the moderately- and poorly-differentiated tumors or between different tumor grades and PET scores |
3 |
| 50. Ronot M, Vilgrain V. Imaging of benign hepatocellular lesions: current concepts and recent updates. [Review]. Clin Res Hepatol Gastroenterol. 38(6):681-8, 2014 Dec. |
Review/Other-Dx |
N/A |
To review updated imaging techniques for focal nodular hyperplasia (FNH) and hepatocellular adenoma (HCA). |
No results stated in abstract. |
4 |
| 51. Forner A, Vilana R, Ayuso C, et al. Diagnosis of hepatic nodules 20 mm or smaller in cirrhosis: Prospective validation of the noninvasive diagnostic criteria for hepatocellular carcinoma. Hepatology. 2008;47(1):97-104. |
Experimental-Dx |
89 patients
Note: CEUS was performed. T1 and T2 weighted MRI as well as contrast enhance MRI performed. |
To evaluate the accuracy of contrast-enhanced ultrasound (CEUS) and MRI for the diagnosis of solitary nodules of 20 mm or smaller detected during surveillance in patients with cirrhosis |
Final diagnoses were: HCC (n = 60), cholangiocarcinoma (n = 1), and benign lesions (regenerative/dysplastic nodule, hemangioma, focal nodular hyperplasia) (n = 28). Sex, cirrhosis cause, liver function, and alpha-fetoprotein (AFP) levels were similar between HCC and non-HCC groups. HCC patients were older and their nodules significantly larger (P < 0.0001). First biopsy was positive in 42 of 60 HCC patients. Sensitivity, specificity, and positive and negative predictive values of conclusive profile were 61.7%, 96.6%, 97.4%, and 54.9%, for MRI, 51.7%, 93.1%, 93.9%, and 50.9%, for CEUS. Values for coincidental conclusive findings in both techniques were 33.3%, 100%, 100%, and 42%. Thus, diagnosis of HCC 20 mm or smaller can be established without a positive biopsy if both CEUS and MRI are conclusive. However, sensitivity of these noninvasive criteria is 33% and, as occurs with biopsy, absence of a conclusive pattern does not rule out malignancy. |
2 |
| 52. Marrero JA, Hussain HK, Nghiem HV, Umar R, Fontana RJ, Lok AS. Improving the prediction of hepatocellular carcinoma in cirrhotic patients with an arterially-enhancing liver mass. Liver Transpl. 2005;11(3):281-289. |
Observational-Dx |
94 patients |
To determine whether clinical, laboratory, and / or radiologic data can improve the prediction of HCC in cirrhotic patients with an arterially-enhancing mass. |
Delayed hypointensity of an arterially-enhancing mass had a sensitivity of 89% and a specificity of 96% for HCC. The presence of delayed hypointensity was the only independent predictor of HCC among patients with arterially-enhancing lesions <2 cm (odds ratio, 6.3; 95% confidence interval [CI], 1.8-13), with a sensitivity of 80% and a specificity of 95%. |
3 |
| 53. Ooka Y, Kanai F, Okabe S, et al. Gadoxetic acid-enhanced MRI compared with CT during angiography in the diagnosis of hepatocellular carcinoma. Magn Reson Imaging. 31(5):748-54, 2013 Jun. |
Observational-Dx |
54 patients
|
To assess the value of gadoxetic acid-enhanced magnetic resonance imaging (MRI) for the pre-therapeutic detection of hepatocellular carcinoma (HCC) using receiver operating characteristic (ROC) analysis with the combination of computed tomography (CT) arterial portography and CT hepatic arteriography (CTAP/CTHA). |
NOTE: Contrast enhanced CT and Contrast enhanced MRI performed.For each reader, the area under the curve was significantly higher for Set 2 than for Set 1. The mean area under the curve was also significantly greater for Set 2 than for Set 1 (area under the curve, 0.98 vs. 0.93; P=.0009). The sensitivity was significantly higher for Set 2 than for Set 1 for all three readers (P=.012, .013 and .039, respectively). The difference in |
2 |
| 54. Rhee H, Kim MJ, Park MS, Kim KA. Differentiation of early hepatocellular carcinoma from benign hepatocellular nodules on gadoxetic acid-enhanced MRI. Br J Radiol. 2012;85(1018):e837-844. |
Observational-Dx |
34 patients |
To test new diagnostic criteria for the discrimination of early hepatocellular carcinoma (HCC) from benign hepatocellular nodules on gadoxetic acid-enhanced MRI (Gd-EOB-MRI). |
A size cut-off value (>/=1.5 cm diameter) and MRI findings of T(1) hypointensity, T(2) hyperintensity, DWI hyperintensity on both low and high b-value images (b=50 and 800 s mm(-2), respectively), arterial enhancement, late washout and hepatobiliary hypointensity were selected as the diagnostic criteria. When lesions were considered malignant if they satisfied three or more of the above criteria, the sensitivity was significantly higher than when making a diagnosis based on arterial enhancement and washout alone (58.6% vs 13.8%, respectively; p=0.0002), while the specificity was 100.0% for both criteria. |
2 |
| 55. Kudo M. Real practice of hepatocellular carcinoma in Japan: conclusions of the Japan Society of Hepatology 2009 Kobe Congress. Oncology. 2010;78 Suppl 1:180-188. |
Review/Other-Dx |
N/A |
To present the current consensus on the management of hepatocellular carcinoma (HCC) formed at the 45th Annual Meeting of the Japan Society of Hepatology (June 4-5, 2009) and the 3rd International Kobe Liver Symposium (June 6-7, 2009) held in Kobe. |
(1) Patients with type B or type C liver cirrhosis, who are an ultrahigh-risk group of liver cancer, should be screened every 3-4 months by ultrasonography and measurement of AFP and PIVKA-II. (2) Gd-EOB-MRI is useful for the diagnosis of early HCC. (3) The JIS score is more useful for the staging of liver cancer than the BCLC staging system, which is a global standard. (4) The TNM staging system by the Liver Cancer Study Group of Japan is superior to the TNM stage by the AJCC/UICC. (5) The therapeutic algorithm in the Japanese guidelines for the management of liver cancer is superior to the BCLC treatment algorithm. (6) Early stage. Liver cancers should be treated by radiofrequency ablation if they are </=2 cm, and by surgical resection if they are Child-Pugh A solitary lesions. (7) Liver transplantation is only indicated for Child-Pugh C patients within Milan Criteria. |
4 |
| 56. Liu X, Jiang H, Chen J, Zhou Y, Huang Z, Song B. Gadoxetic acid disodium-enhanced magnetic resonance imaging outperformed multidetector computed tomography in diagnosing small hepatocellular carcinoma: A meta-analysis. [Review]. Liver Transpl. 23(12):1505-1518, 2017 12. |
Review/Other-Dx |
27 studies
3,516 patients |
To review the diagnostic performance of gadoxetic acid disodium (Gd-EOB-DTPA)-enhanced magnetic resonance imaging (MRI) and multidetector computed tomography (MDCT) in diagnosing small hepatocellular carcinoma (HCC) lesions measuring up to 2?cm (=2?cm). |
Gd-EOB-DTPA-enhanced MRI demonstrated significantly higher overall sensitivity than did MDCT (0.96 versus 0.65; P?<?0.01), without substantial loss of specificity (0.94 versus 0.98; P?>?0.05). Area under the summary receiver operating characteristic curve was 0.97 with Gd-EOB-DTPA-enhanced MRI and 0.85 with MDCT. Regarding Gd-EOB-DTPA-enhanced MRI, sensitivity was significantly higher for studies from non-Asian countries than Asian countries (0.96 versus 0.93; P?<?0.01), for retrospective studies than prospective studies (0.95 versus 0.91; P?<?0.01), and for those with Gd-EOB-DTPA injection rate?=?1.5?mL/s than that of <1.5?mL/s (0.97 versus 0.90; P?<?0.01). |
4 |
| 57. Pietryga JA, Burke LM, Marin D, Jaffe TA, Bashir MR. Respiratory motion artifact affecting hepatic arterial phase imaging with gadoxetate disodium: examination recovery with a multiple arterial phase acquisition. Radiology. 271(2):426-34, 2014 May. |
Observational-Dx |
549 MR examinations |
To determine whether the use of a multiple arterial phase imaging technique provides adequate image quality in patients experiencing transient severe motion (TSM) in the arterial phase on abdominal magnetic resonance (MR) images obtained with gadoxetate disodium. |
Mean motion scores in all three arterial phases in the gadoxetate disodium cohort were significantly worse than those in the gadobenate dimeglumine cohort (P < .005). TSM occurred at a higher rate with gadoxetate disodium than with gadobenate dimeglumine (10.7% [37 of 345 examinations] vs 0.5% [one of 204 examinations], P < .001). However, 30 of 37 examinations affected by TSM had at least one well-timed arterial phase with a mean motion score of 3 or less and were thus considered adequate. |
3 |
| 58. Allen BC, Ho LM, Jaffe TA, Miller CM, Mazurowski MA, Bashir MR. Comparison of Visualization Rates of LI-RADS Version 2014 Major Features With IV Gadobenate Dimeglumine or Gadoxetate Disodium in Patients at Risk for Hepatocellular Carcinoma. AJR. American Journal of Roentgenology. 210(6):1266-1272, 2018 Jun. |
Observational-Dx |
247 Nodules |
To compare visualization rates of the major features covered by Liver Imaging Reporting and Data System (LI-RADS) version 2014 in patients at risk for hepatocellular carcinoma using either gadobenate dimeglumine or gadoxetate disodium IV contrast agent. |
Arterial phase hyperenhancement was seen in a similar number of nodules with gadobenate dimeglumine (mean, 91.5% [119/130]) and gadoxetate disodium (mean, 88.0% [103/117]) (p = 0.173). Dynamic phase washout was more commonly seen with gadobenate dimeglumine (mean, 60.2% [78.3/130]) than with gadoxetate disodium (mean, 45.3% [53/117]) (p = 0.006). The capsule feature was more often visualized with gadobenate dimeglumine (mean, 50.2% [65.3/130]) than with gadoxetate disodium (mean, 33.3% [39/117]) (p < 0.001). Interreader agreement for arterial phase enhancement and dynamic phase washout was almost perfect for both contrast agents (? > 0.83). Agreement for the capsule feature was moderate for gadobenate dimeglumine (? = 0.52) and substantial for gadoxetate disodium (? = 0.67). |
4 |
| 59. Marks RM, Ryan A, Heba ER, et al. Diagnostic per-patient accuracy of an abbreviated hepatobiliary phase gadoxetic acid-enhanced MRI for hepatocellular carcinoma surveillance. AJR Am J Roentgenol. 204(3):527-35, 2015 Mar. |
Observational-Dx |
298 Patients |
To evaluate the per-patient diagnostic performance of an abbreviated gadoxetic acid-enhanced MRI protocol for hepatocellular carcinoma (HCC) surveillance. |
Interreader agreement was substantial for both image sets (? = 0.72 for both) and intrareader agreement was excellent (? = 0.97-0.99). Reader performance for image set 1 was sensitivity of 85.7% for reader A and 79.6% for reader B, specificity of 91.2% for reader A and 95.2% for reader B, and negative predictive value of 97.0% for reader A and 96.0% for reader B. Reader performance for image set 2 was nearly identical, with only one of 298 examinations scored differently on image set 2 compared with set 1. |
2 |
| 60. Besa C, Lewis S, Pandharipande PV, et al. Hepatocellular carcinoma detection: diagnostic performance of a simulated abbreviated MRI protocol combining diffusion-weighted and T1-weighted imaging at the delayed phase post gadoxetic acid. Abdom Radiol. 42(1):179-190, 2017 01. |
Observational-Dx |
174 Patients |
To evaluate the diagnostic performance of a "simulated" abbreviated MRI (AMRI) protocol using diffusion-weighted imaging (DWI) and T1-weighted (T1w) imaging obtained at the hepatobiliary phase (HBP) post gadoxetic acid injection alone and in combination, compared to dynamic contrast-enhanced (CE)-T1w imaging for the detection of hepatocellular carcinoma (HCC). |
174 patients including 62 with 80 HCCs were assessed. Equivalent per-patient sensitivity and negative predictive value (NPV) were observed for DWI (85.5% and 92.2%, pooled data) and T1w-HBP (89.8% and 94.2%) (P = 0.1-0.7), while these were significantly lower for the full AMRI protocol (DWI+T1w-HBP, 80.6% and 80%, P = 0.02) when compared to CE-set (90.3% and 94.9%). Higher specificity and positive predictive value were observed for CE-set vs. AMRI (P = 0.02). The estimated cost reduction of AMRI versus full MRI ranged between 30.7 and 49.0%. |
3 |
| 61. Tillman BG, Gorman JD, Hru JM, et al. Diagnostic per-lesion performance of a simulated gadoxetate disodium-enhanced abbreviated MRI protocol for hepatocellular carcinoma screening. Clin Radiol. 73(5):485-493, 2018 May. |
Observational-Dx |
79 Patients |
To evaluate the diagnostic per-lesion performance of a simulated gadoxetate disodium-enhanced abbreviated MRI (AMRI) in cirrhotic and chronic hepatitis B (CHB) patients for hepatocellular carcinoma (HCC) screening. |
Inter-reader agreement was substantial (? = 0.75). The final reference standard showed 27 HCCs in 13 patients (median 21 mm, range 11-100 mm). The two readers each correctly scored 23 as suspicious for HCC (sensitivity = 85.2%), scored a total of 27 and 32 observations as suspicious for HCC (positive predictive value [PPV] = 85.2% and 71.9%), and scored 83 and 78 observations or complete examinations as negative for HCC (negative predictive value [NPV] = 95.2% and 94.9%). |
3 |
| 62. Korean Liver Cancer Association (KLCA), National Cancer Center (NCC), Goyang, Korea. 2018 Korean Liver Cancer Association-National Cancer Center Korea Practice Guidelines for the Management of Hepatocellular Carcinoma. [Review]. Korean Journal of Radiology. 20(7):1042-1113, 2019 Jul. |
Review/Other-Dx |
N/A |
To provide useful and constructive advice for the clinical management of patients with hepatocellular carcinoma (HCC). |
No results stated in abstract. |
4 |
| 63. Clinical Practice Guidelines for Hepatocellular Carcinoma Differ between Japan, United States, and Europe. Liver Cancer 2015;4:85-95. |
Review/Other-Dx |
N/A |
To discuss differences between the European and American clinical practice guidelines and Japanese clinical practice guidelines for liver cancer. |
No abstract available. |
4 |
| 64. Yang B, Zhang B, Xu Y, et al. Prospective study of early detection for primary liver cancer. Journal of Cancer Research & Clinical Oncology. 123(6):357-60, 1997. |
Experimental-Tx |
17920 subjects |
To determine whether repeated screening can lead to early detection of primary liver cancer (PLC) and in turn to an improved clinical result. |
All subjects enrolled were followed up and classed at the end-point as alive without liver cancer, alive with liver cancer, dead from liver cancer, or dead from another cause. The mean follow-up was 1.2 years; total follow-up was 12,038 person-years in the screening group and 9,573 person-years in the control group. We detected 38 patients with PLC in the screening group and 18 patients with PLC in the control group. In the patients in the screening group 76.8% of patients were at a subclinical stage, and 70.6% of them underwent resection, the 1- and 2-year survival rates being 88.1% and 77.5%, respectively. However, in the control group, none of the patients was at a subclinical stage when diagnosed, none of them underwent resection, and none of them survived over 1 year. The lead time was estimated at 0.45 years. The cost of detecting PLC at an early stage was RMB 12,600 (US$1,500). |
1 |
| 65. Choi DT, Kum HC, Park S, et al. Hepatocellular Carcinoma Screening Is Associated With Increased Survival of Patients With Cirrhosis. Clinical Gastroenterology & Hepatology. 17(5):976-987.e4, 2019 Apr. |
Observational-Dx |
13,714 patients |
To characterize utilization of hepatocelular carcinoma (HCC) screening receipt and its association with early tumor detection and improved survival in a nationally representative cohort of patients in the United States. |
Most patients with cirrhosis (51.1%) did not receive any screening in the 3 years before a diagnosis of HCC, and only 6.8% of patients underwent consistent annual screening. The proportion with consistent screening increased from 5.4% in 2003 to 2006 to 8.8% in 2011 to 2013 (P < .001). The mean proportion of time covered was 13.4% overall, which increased from 11.7% in 2003 to 2006 to 15.2% in 2011 to 2013. Receipt of consistent screening was associated with detection of early stage tumors (odds ratio, 1.98; 95% CI, 1.68-2.33) and a reduced risk of death after correction for lead-time bias (hazard ratio, 0.76; 95% CI, 0.70-0.83). Inconsistent screening was associated with a slightly smaller increase in early detection of HCC (odds ratio, 1.31; 95% CI, 1.20-1.43) and a reduced risk of death (hazard ratio, 0.86; 95% CI, 0.83-0.90). After correction for lead- and length-time biases, higher proportions of patients with consistent (23%; 95% CI, 21%-25%) and inconsistent screening (19%; 95% CI, 19%-20%) survived for 3 years compared with patients without screening (13%; 95% CI, 12%-14%). |
4 |
| 66. Singal AG, Mittal S, Yerokun OA, et al. Hepatocellular Carcinoma Screening Associated with Early Tumor Detection and Improved Survival Among Patients with Cirrhosis in the US. Am J Med 2017;130:1099-106 e1. |
Observational-Dx |
374 patients |
To characterize the association between hepatocellular carcinoma screening and early tumor detection, curative treatment, and overall survival among patients with cirrhosis. |
Among 374 hepatocellular carcinoma patients, 42% (n = 157) were detected by screening. Screen-detected patients had a significantly higher proportion of early tumors (Barcelona Clinic Liver Cancer stage A 63.1% vs 36.4%, P <.001) and were more likely to undergo curative treatment (31% vs 13%, P = .02). Hepatocellular carcinoma screening was significantly associated with improved survival in multivariate analysis (hazards ratio 0.41; 95% confidence interval, 0.26-0.65) after adjusting for patient demographics, Child-Pugh class, and performance status. Median survival of screen-detected patients was 14.6 months, compared with 6.0 months for non-screen-detected patients, with the difference remaining significant after adjusting for lead-time bias (hazards ratio 0.59, 95% confidence interval, 0.37-0.93). |
4 |
| 67. D'Onofrio M, Faccioli N, Zamboni G, et al. Focal liver lesions in cirrhosis: value of contrast-enhanced ultrasonography compared with Doppler ultrasound and alpha-fetoprotein levels. Radiol Med. 2008;113(7):978-991. |
Observational-Dx |
128 cirrhotic patients
Note: Contrast enhanced ultrasound performed. |
To evaluate the diagnostic value of contrast-enhanced ultrasound (CEUS) in characterising focal liver lesions in cirrhosis and to validate its use in lesions discovered during surveillance for hepatocellular carcinoma (HCC). |
A total of 207 focal liver lesions (101 benign and 106 malignant) were identified in 128 patients. CEUS sensitivity and specificity for lesion characterisation were 96.2% and 97.0%, respectively, whereas its positive and negative predictive values were 97.1% and 96.1%. CEUS accuracy was 96.6%, higher than that of US (72.0%), Doppler US (70.0%), AFP levels (65.7%), combined US and Doppler US (70.0%) and combined US and AFP levels (90.3%). The differences between US and CEUS were statistically significant (p<0.05). |
3 |
| 68. Wang JH, Lu SN, Hung CH, et al. Small hepatic nodules (< or =2 cm) in cirrhosis patients: characterization with contrast-enhanced ultrasonography. Liver Int. 2006;26(8):928-934. |
Observational-Dx |
30 cirrhosis patients |
To evaluate the efficacy of contrast-enhanced ultrasonography (CEUS) for the characterization of small hepatic nodules (< or =2 cm) in cirrhosis patients. |
CEUS showed AE in 15 nodules (13 HCC and two benign) and ADE in 17 lesions (14 HCC and three benign). For HCC, the coincidental AE of both CEUS and dynamic CT was 40%. Using both AE and ADE for HCC diagnosis, the sensitivity, specificity, accuracy, positive predictive value and negative predictive values were 55.6%, 91.7%, 70%, 90.9% and 57.9%, respectively. When using either AE or ADE for HCC diagnosis, the same parameters were 94.4%, 66.7%, 83.3%, 81% and 88.9%, respectively. One benign hepatic nodule with both AE and ADE was diagnosed as HCC 29 months after the CEUS study. |
3 |
| 69. Claudon M, Dietrich CF, Choi BI, et al. Guidelines and good clinical practice recommendations for Contrast Enhanced Ultrasound (CEUS) in the liver - update 2012: A WFUMB-EFSUMB initiative in cooperation with representatives of AFSUMB, AIUM, ASUM, FLAUS and ICUS. Ultrasound Med Biol. 2013;39(2):187-210. |
Review/Other-Dx |
N/A |
To provide general advice on the use of all currently clinically available ultrasound contrast agents (UCA). |
No results stated in abstract. |
4 |
| 70. Gallotti A, D'Onofrio M, Romanini L, Cantisani V, Pozzi Mucelli R. Acoustic Radiation Force Impulse (ARFI) ultrasound imaging of solid focal liver lesions. Eur J Radiol. 81(3):451-5, 2012 Mar. |
Observational-Dx |
40 Lesions |
To evaluate the application of Acoustic Radiation Force Impulse (ARFI) ultrasound imaging and its potential value for characterizing focal solid liver lesions. |
40 lesions were evaluated and a total of 400 measurements were obtained. The lesions were: 6/40(15%) hepatocellular carcinomas, 7/40(17.5%) hemangiomas, 5/40(12.5%) adenomas, 9/40(22.5%) metastases and 13/40(32.5%) focal nodular hyperplasias. The total mean values obtained were: 2.17 m/s in HCCs, 2.30 m/s in hemangiomas, 1.25 m/s in adenomas, 2.87 m/s in metastases and 2.75 m/s in FNHs. The inter-operator evaluation resulted non-statistically different (p>0.05). A significant difference (p<0.05) was always found by comparing adenomas to the other lesions. 160 measurements were obtained in the surrounding parenchyma, with a no significant difference between values measured in adenomas and in the surrounding liver. |
3 |
| 71. Park H, Park JY, Kim DY, et al. Characterization of focal liver masses using acoustic radiation force impulse elastography. World Journal of Gastroenterology. 19(2):219-26, 2013 Jan 14. |
Observational-Dx |
47 Patients |
To investigate the diagnostic performance of acoustic radiation force impulse (ARFI) elastography for characterizing focal liver mass by quantifying their stiffness. |
After further excluding three masses that were non-diagnostic on biopsy, a total of 47 focal mass lesions were tested, including 39 (83.0%) malignant masses [24 hepatocellular carcinomas (HCC), seven cholangiocellular carcinomas (CCC), and eight liver metastases] and eight (17.0%) benign masses (five hemangiomas and three focal nodular hyperplasias, FNH). Thirty-seven (74.0%) masses were confirmed by histological examination. The mean velocity was 2.48 m/s in HCCs, 1.65 m/s in CCCs, 2.35 m/s in metastases, 1.83 m/s in hemangiomas, and 0.97 m/s in FNHs. Although considerable overlap was still noted between malignant and benign masses, significant differences in ARFI values were observed between malignant and benign masses (mean 2.31 m/s vs 1.51 m/s, P = 0.047), as well as between HCCs and benign masses (mean 2.48 m/s vs 1.51 m/s, P = 0.006). The areas under the receiver operating characteristics curves (AUROC) for discriminating the malignant masses from benign masses was 0.724 (95%CI, 0.566-0.883, P = 0.048), and the AUROC for discriminating HCCs from benign masses was 0.813 (95%CI, 0.649-0.976, P = 0.008). To maximize the sum of sensitivity and specificity, an ARFI value of 1.82 m/s was selected as the cutoff value to differentiate malignant from benign liver masses. Furthermore, the cutoff value for distinguishing HCCs from benign masses was also determined to be 1.82 m/s. The diagnostic performance of the sum of the ARFI values for focal liver masses and the surrounding liver parenchyma to differentiate liver masses improved (AUROC = 0.853; 95%CI, 0.745-0.960; P = 0.002 in malignant liver masses vs benign ones and AUROC = 0.948; 95%CI, 0.896-0.992, P < 0.001 in HCCs vs benign masses). |
4 |
| 72. Doyle DJ, O'Malley ME, Jang HJ, Jhaveri K. Value of the unenhanced phase for detection of hepatocellular carcinomas 3 cm or less when performing multiphase computed tomography in patients with cirrhosis. J Comput Assist Tomogr. 2007;31(1):86-92. |
Observational-Dx |
36 patients. Note: Dual-phase CT. with and without contrast performed. |
To determine whether unenhanced images are of added benefit to dual-phase computed tomography (CT) for detection of hepatocellular carcinomas (HCCs) 3 cm or less. |
For readers 1 and 2, unenhanced CT was subjectively helpful in 16 (5%) of 324 and 23 (7%) of 324 segments. Sensitivity and area under the receiver operating characteristic curve were identical for dual-phase versus triple-phase images for reader 1 (82.4% and 0.882) and reader 2 (100% and 0.997). |
2 |
| 73. Iannaccone R, Laghi A, Catalano C, et al. Hepatocellular carcinoma: role of unenhanced and delayed phase multi-detector row helical CT in patients with cirrhosis. Radiology. 2005;234(2):460-467. |
Observational-Dx |
195 patients. Note: Quadruple-phase CT performed. |
To determine, by using multi-detector row helical computed tomography (CT), the added value of obtaining unenhanced and delayed phase scans in addition to biphasic (hepatic arterial and portal venous phases) scans in the detection of hepatocellular carcinoma (HCC) in patients with cirrhosis. |
Mean sensitivity and positive predictive values, respectively, for HCC detection were 88.8% (666 of 750 readings) and 97.8% (666 of 681 readings) for the combined hepatic arterial and portal venous phases, 89.2% (669 of 750 readings) and 97.8% (669 of 684 readings) for hepatic arterial and portal venous phases with the unenhanced phase, 92.8% (696 of 750 readings) and 97.3% (696 of 715 readings) for hepatic arterial and portal venous phases with the delayed phase, and 92.8% (696 of 750 readings) and 97.3% (696 of 715 readings) for all four phases combined. The reading sessions in which delayed phase images were available for interpretation showed significantly (P < .05) superior sensitivity and A(z) values. |
2 |
| 74. Choi JY, Lee JM, Sirlin CB. CT and MR imaging diagnosis and staging of hepatocellular carcinoma: part I. Development, growth, and spread: key pathologic and imaging aspects. [Review]. Radiology. 272(3):635-54, 2014 Sep. |
Review/Other-Dx |
N/A |
To discuss the current state of the art for the imaging-based diagnosis and staging of HCC, focusing on CT and MR imaging, as these are the most commonly used modalities for these purposes. |
No results stated in abstract. |
4 |
| 75. EASL-EORTC clinical practice guidelines: management of hepatocellular carcinoma. J Hepatol. 2012;56(4):908-943. |
Review/Other-Tx |
N/A |
To provide EASL–EORTC Clinical Practice Guidelines for the management of hepatocellular carcinoma. |
n/a |
4 |
| 76. Wang XY, Chen D, Zhang XS, Chen ZF, Hu AB. Value of 18F-FDG-PET/CT in the detection of recurrent hepatocellular carcinoma after hepatectomy or radiofrequency ablation: a comparative study with contrast-enhanced ultrasound. J Dig Dis. 14(8):433-8, 2013 Aug. |
Observational-Dx |
36 patients |
To evaluate the role of positron emission tomography/computer tomography with fluorine-18 fluorodeoxyglucose ((18) F-FDG-PET/CT) in detecting hepatocellular carcinoma (HCC) recurrence after hepatectomy and/or radiofrequency ablation (RFA) and to compare its efficacy with contrast-enhanced ultrasound (CEUS). |
In all, 32 patients were confirmed to have HCC recurrence by pathology and clinical follow-up. The sensitivity, specificity, positive predictive value, negative predictive value and accuracy of (18) F-FDG-PET/CT for intrahepatic HCC recurrence were 96.7%, 83.3%, 96.7%, 83.3% and 94.4%, respectively. The corresponding values of CEUS were 56.7%, 100%, 100%, 31.6% and 63.9%, respectively. The sensitivity and accuracy of (18) F-FDG-PET/CT for the diagnosis of HCC recurrence were significantly higher than those of CEUS (P?<?0.01, respectively). |
4 |
| 77. NCCN Clinical Practice Guidelines in Oncology. Hepatobiliary Cancers. Version 1.2018. Available at: https://www.nccn.org/professionals/physician_gls/pdf/hepatobiliary.pdf. Accessed December 30, 2018 |
Review/Other-Dx |
N/A |
To provide clinical practice guidelines for hepatobiliary cancers. |
No abstract available. |
4 |
| 78. Roberts LR, Sirlin CB, Zaiem F, et al. Imaging for the diagnosis of hepatocellular carcinoma: A systematic review and meta-analysis. [Review]. Hepatology. 67(1):401-421, 2018 01. |
Observational-Dx |
33 studies |
To determine if there is a relative diagnostic benefit of multiphasic computed tomography (CT) versus magnetic resonance imaging (MRI), we synthesized evidence regarding the relative performance of CT, extracellular contrast-enhanced MRI, and gadoxetate-enhanced MRI for diagnosis of hepatocellular carcinoma (HCC) in patients with cirrhosis. We also assessed whether liver biopsy versus follow-up with the same versus alternative imaging is best for CT-indeterminate or MRI-indeterminate liver nodules in patients with cirrhosis. |
Of 33 included studies, 19 were comprehensive, while 14 reported sensitivity only. For all tumor sizes, the 19 comprehensive comparisons showed significantly higher sensitivity (0.82 versus 0.66) and lower negative likelihood ratio (0.20 versus 0.37) for MRI over CT. The specificities of MRI versus CT (0.91 versus 0.92) and the positive likelihood ratios (8.8 versus 8.1) were not different. All three modalities performed better for HCCs =2 cm. Performance was poor for HCCs <1 cm. No studies examined whether adults with cirrhosis and an indeterminate nodule are best evaluated using biopsy, repeated imaging, or alternative imaging. |
4 |
| 79. Jiang T, Zhao Q, Huang M, Sun J, Tian G. Contrast-Enhanced Ultrasound in Residual Tumor of Hepatocellular Carcinoma following Transarterial Chemoembolization: Is It Helpful for Tumor Response?. Biomed Res Int. 2018:8632069, 2018. |
Observational-Dx |
73 Patients |
To investigate the enhancement pattern of residual tumor on contrast-enhanced ultrasonography (CEUS) in patients with hepatocellular carcinoma (HCC) treated with transarterial chemoembolization (TACE). |
In group 1, the mean rise time, peak time, and washout times in group 1 were 16.1±2.7?sec, 31.3±3.1?sec, and 191.0±31.3?sec, respectively. In group 2, these were 15.1±3.5?sec, 30.9±3.2?sec, and 142.6±16.1?sec, respectively. The differences in rise time and peak time were not statistically significant (P=0.09 and 0.30, respectively), but the washout time was significantly prolonged in group 1 (P<0.01). The enhanced pattern in arterial phase was inhomogeneous (n=11), regular homogeneous (n=11), partial (n=12), peripheral (n=7), and peripheral rim-like (n=2) in group 1. The average of the longest tumor size of the whole lesion in the 5 types was 4.7±1.3cm, 2.9±1.0cm, 3.1±1.7cm, 2.5±0.6cm, and 2.1?cm. |
3 |
| 80. Cao J, Dong Y, Mao F, Wang W. Dynamic Three-Dimensional Contrast-Enhanced Ultrasound to Predict Therapeutic Response of Radiofrequency Ablation in Hepatocellular Carcinoma: Preliminary Findings. Biomed Res Int. 2018:6469703, 2018. |
Observational-Dx |
42 Patients |
To investigate the value of dynamic three-dimensional contrast-enhanced ultrasound (3D-CEUS) in the assessment of therapeutic response of hepatocellular carcinoma (HCC) treated with radiofrequency ablation (RFA). |
After RFA treatment, 3D-CEUS was successfully conducted in 34 HCC lesions. CR was observed on both 2D-CEUS and 3D-CEUS in 25/42 (59.5%) HCC and RT in 6/42 (14.3%) HCC lesions. In 3/42 (7.1%) HCC lesion, RT was documented by SOR and 3D-CEUS, but it was not appreciable at 2D-CEUS. In 3/42 (7.1%) HCC lesion, the presence of peripheral RT was suspected by both 2D-CEUS and 3D-CEUS, but it was not confirmed by SOR. No statistically significant difference between 2D-CEUS and 3D-CEUS in depicting either CR or RT was found (P = 0.25). Combined with dynamic 3D-CEUS, the diagnostic accuracy was improved from 85.7% to 92.9%. |
3 |
| 81. Hu J, Bhayana D, Burak KW, Wilson SR. Resolution of indeterminate MRI with CEUS in patients at high risk for hepatocellular carcinoma. Abdominal Radiology. 45(1):123-133, 2020 01. |
Observational-Dx |
42 patients |
To show the contribution of contrast-enhanced ultrasound (CEUS) to characterization of indeterminate MRI observations in high-risk patients for hepatocellular carcinoma (HCC). |
A majority, 37/50 (74%), of indeterminate nodule-like observations have arterial phase enhancement without washout on MRI. CEUS further characterizes enhancement and shows washout in 14/37 (38%). In total, CEUS diagnoses 16 malignant lesions in 14 patients including 14 HCC and 2 ICC. 12/16 (75%) malignant lesions are confirmed by biopsy or follow-up. Ultrasound identification of a nodule differentiates real nodules from pseudolesions. Of the ten suspected arterial-portal shunts on MRI, two show a real nodule on ultrasound, confirmed as an HCC and a regenerative nodule. 15/42 (36%) patients have LI-RADS escalated from LR-3 or 4 on MRI to LR-4 or 5 on CEUS. Overall, the sensitivity of CEUS is (13/16) 81.3% and specificity is (37/37) 100% for malignant diagnosis. |
2 |
| 82. Zhang P, Zhou P, Tian SM, Qian Y, Deng J, Zhang L. Application of acoustic radiation force impulse imaging for the evaluation of focal liver lesion elasticity. Hepatobiliary Pancreat Dis Int. 12(2):165-70, 2013 Apr. |
Observational-Dx |
140 patients |
To evaluate the performance of ARFI in noninvasive assessment of the tissue stiffness of focal liver lesion (FLL) and to explore its potential value in the differential diagnosis of FLL. |
The VTTQ median values of ANGI, FNH, HCC, metastasis and CCC were 1.30, 1.80, 2.52, 3.08 and 3.89 m/s, respectively. A significant increase in the VTTQ values of different lesions was observed: ANGI<FNH<HCC<InvalidTagstasis<CCC (P<0.001). The AUROC (95% CI) of VTTQ values was 0.94 (0.90-0.98) for ANGI, 0.91 (0.87-0.96) for malignant lesions and 0.87 (0.79-0.94) for CCC. The sensitivity and specificity for ANGI (86.5%, 89.3%, respectively), malignancy (81.3%, 92.9%, respectively), and CCC (91.7%, 72.5%, respectively) were associated with VTTQ cut-off values of 1.76, 2.22 and 3.00 m/s, respectively. |
4 |
| 83. American College of Radiology. ACR Appropriateness Criteria® Radiation Dose Assessment Introduction. Available at: https://www.acr.org/-/media/ACR/Files/Appropriateness-Criteria/RadiationDoseAssessmentIntro.pdf. |
Review/Other-Dx |
N/A |
To provide evidence-based guidelines on exposure of patients to ionizing radiation. |
No abstract available. |
4 |
