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. 2020 Sep;9(5):503-517.
doi: 10.1159/000506834. Epub 2020 Aug 6.

A Comparison of Biannual Two-Phase Low-Dose Liver CT and US for HCC Surveillance in a Group at High Risk of HCC Development

Jeong Hee Yoon  1   2 , Jeong Min Lee  1   2   3 , Dong Ho Lee  1   2 , Ijin Joo  1   2 , Ju Hyun Jeon  1   2 , Su Joa Ahn  1   2 , Seung-Taek Kim  1   2 , Eun Ju Cho  4 , Jeong-Hoon Lee  4 , Su Jong Yu  4 , Yoon Jun Kim  4 , Jung-Hwan Yoon  4
Affiliations

A Comparison of Biannual Two-Phase Low-Dose Liver CT and US for HCC Surveillance in a Group at High Risk of HCC Development

Jeong Hee Yoon et al. Liver Cancer. 2020 Sep.

Abstract

Background and aims: Biannual ultrasonography (US) is a current recommendation for hepatocellular carcinoma (HCC) surveillance in a high-risk group. The sensitivity of US, however, has been low in patients with a high risk of developing HCC. We aimed to compare sensitivity for HCC of biannual US and two-phase low-dose computed tomography (LDCT) in patients with a high risk of HCC.

Methods: In this prospective single-arm study, participants with an annual risk of HCC greater than 5% (based on a risk index of ≥2.33) and who did not have a history of HCC were enrolled from November 2014 to July 2016. Participants underwent paired biannual US and two-phase LDCT 1-3 times. Two-phase LDCT included arterial and 3-min delayed phases. The sensitivity, specificity, and positive predictive value of HCC detection using US and two-phase LDCT were compared using a composite algorithm as a standard of reference.

Results: Of the 139 enrolled participants, 137 underwent both the biannual US and two-phase LDCT at least once and had follow-up images. Among them, 27 cases of HCC (mean size: 14 ± 4 mm) developed in 24 participants over 1.5 years. Two-phase LDCT showed a significantly higher sensitivity (83.3% [20/24] vs. 29.2% [7/24], p < 0.001) and specificity (95.6% [108/113] vs. 87.7% [99/113], p =0.03) than US. A false-positive result was reported in 14 participants at US and 5 participants at two-phase LDCT, resulting in a significantly higher positive predictive value of two-phase LDCT (33.3% [7/21] vs. 80% [20/25], p < 0.001).

Conclusions: Patients with a risk index ≥2.33 showed a high annual incidence of HCC development in our study, and two-phase LDCT showed significantly higher sensitivity and specificity for HCC detection than US.

Keywords: Cirrhosis; Hepatocellular carcinoma; Low-dose CT; Surveillance; Ultrasonography.

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Conflict of interest statement

Jeong Hee Yoon: activities related to the present article: disclosed no relevant relationship. Activities not related to the present article: the author previously received grants from Bayer; and personal fees from Philips Healthcare, Samsung Electronics, and Bayer. Jeong Min Lee: activities related to the present article: disclosed no relevant relationship. Activities not related to the present article: the author previously received nonfinancial technical support from Siemens Healthineers and Philips Healthcare; grants from Dongseo Medical, CMS, Acuzen, Starmed, RF Medical, and Bayer; and personal fees from Bayer Healthcare for lectures. Ijin Joo, Dong Ho Lee, Su Joa Ahn, Ju Hyun Jeon, Seung-taak Kim, Eun Ju Cho, Su Jong Yu, and Yoon Jun Kim: disclosed no relevant relationship. Jeong-Hoon Lee: activities related to the present article: disclosed no relevant relationship. Activities not related to the present article: the author previously received lecture fees from GreenCross Cell, Daewoong Pharmaceuticals, and Gilead Korea. Jung-Hwan Yoon: activities related to the present article: disclosed no relevant relationship. Activities not related to the present article: the author previously received research grants from Bayer, Bukwang Pharmaceuticals, and Daewoong Pharmaceuticals.

Figures

Fig. 1
Fig. 1
Study flow. * Participants had follow-up examinations before the withdrawal. † Long interval between each round (>9 months). CT, computed tomography; FU, follow-up; HCC, hepatocellular carcinoma; LDCT, low dose CT; TPL, transplantation; US, ultrasonography.
Fig. 2
Fig. 2
A 58-year-old man with HCC. a No focal hepatic observation was reported at US. b Approximately 15-mm observation with arterial phase hyperenhancement (APHE) and delayed washout is seen at two-phase LDCT (arrowheads). The observation showed APHE and portal washout on gadoxetic acid-enhanced MRI and was clinically diagnosed as an HCC.
Fig. 3
Fig. 3
A 62-year-old man with HCC. a At US, no focal hepatic observation was detected. b At two-phase LDCT, an approximately 10-mm observation with APHE is observed in segment 5 (arrowheads) without delayed washout (not shown). c At subsequent gadoxetic acid-enhanced MRI, the observation shows APHE, hepatobiliary phase defect, and diffusion restriction (arrowheads) and so is regarded as a probable HCC.
Fig. 4
Fig. 4
A 53-year-old man with HCC. No focal hepatic observation was detected at US (not shown). a Approximately 8 mm observation with APHE is seen in the segment 6 subcapsular area (arrowheads) without delayed washout at two-phase LDCT. The observation was reported as an arterioportal shunt. b At follow-up gadoxetic acid-enhanced MRI, however, the observation (14 mm) shows APHE and portal washout (arrowheads) and so is regarded as HCC.
Fig. 5
Fig. 5
A 53-year old woman without HCC. At US, a 13-mm hypoechoic observation is seen in the right lobe of the liver (arrowheads). No observation was detected at two-phase LDCT and follow-up standard-dose four-phase liver CT (not shown).
See this image and copyright information in PMC

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