Zusammenfassung
Hintergrund
Die bildgebende radiologische Diagnostik ist heute aus den Untersuchungen beim hepatozellulären Karzinom (HCC) nicht mehr wegzudenken. Die Multidetektor-Computertomographie (CT) und Magnetresonanztomographie (MRT) spielen hierbei eine entscheidende Rolle. Die Kontrastmittelsonographie (CE-US, „contrast enhanced ultrasound“) stellt zudem für die Charakterisierung des HCC bei einer in der B‑Bild-Sonographie zufällig entdeckten Leberläsion bei Hochrisikopatienten eine Alternative dar.
Methode
Es wurden eine Recherche und Analyse aktueller Literatur durchgeführt.
Ergebnisse
Die CT ist als schnell und universell verfügbare Bildgebungsmodalität eine wichtige Methode zur Diagnostik des HCC. Sie profitiert von den technischen Weiterentwicklungen der letzten Jahrzehnte, die sich neben reduzierter Strahlendosis v. a. in schnellerer Akquisition niederschlagen. Mit der MRT können noch weitere Diagnosekriterien für die Evaluation und Differenzialdiagnose von fokalen Leberläsionen in der zirrhotischen Leber herangezogen werden. Sie ist heute ausreichend robust, um bei den allermeisten Patienten adäquate Bilder zu generieren. Die CE-US ist in der aktuellen nationalen S3-Leitlinie zur Diagnostik und Therapie des HCC als alternatives bildgebendes Verfahren zur CT und MRT für die Charakterisierung des HCC empfohlen, wenn ein unklarer Leberrundherd unabhängig von seiner Größe in einer Hochrisikogruppe in der B‑Bild-Sonographie detektiert wird. Die Vorteile liegen in den geringen Kosten, der raschen Verfügbarkeit, der fehlenden Strahlenbelastung und der fehlenden Nephrotoxizität. Im klinischen Alltag hat sich die Responsebeurteilung mit den mRECIST-Kriterien beim HCC weitestgehend durchgesetzt.
Abstract
Background
Radiological imaging is nowadays an integral part of making the diagnosis in hepatocellular carcinoma (HCC). Multidetector computed tomography (CT) and magnetic resonance imaging (MRI) play a decisive role in this. Contrast-enhanced ultrasound (CE-US) represents an alternative to these for the characterization of incidentally discovered hepatic lesions in B‑image ultrasound in high-risk patients.
Method
A search and analysis of the currently available literature were carried out.
Results
The CT is a rapid and universally available imaging modality which is an important method in the diagnostics of HCC. It has profited from the technical developments over the last decade, which is particularly reflected in the more rapid acquisition in addition to reduced radiation doses. With MRI more diagnostic criteria for the evaluation and differential diagnosis of focal hepatic lesions in a cirrhotic liver can be acquired. Nowadays, it is sufficiently robust to generate adequate images from most patients. In the current national S3 guidelines on the diagnostics and treatment of HCC, CE-US is recommended as an alternative imaging procedure to CT and MRI for characterization of HCC in a high-risk group, when an unclear focal liver nodule is detected in B‑image ultrasound, independent of its size. The advantage lies in the lower costs, rapid availability, lack of radiation exposure and lack of nephrotoxicity. In the clinical routine the response assessment with the mRECIST criteria for HCC has become widely established.
Literatur
Bruix J, Sherman M, American Association for the Study of Liver D (2011) Management of hepatocellular carcinoma: an update. Hepatology 53:1020–1022
Bartolozzi C, Crocetti L, Lencioni R et al (2007) Biliary and reticuloendothelial impairment in hepatocarcinogenesis: the diagnostic role of tissue-specific MR contrast media. Eur Radiol 17:2519–2530
Bartolozzi C, Battaglia V, Bargellini I et al (2013) Contrast-enhanced magnetic resonance imaging of 102 nodules in cirrhosis: correlation with histological findings on explanted livers. Abdom Imaging 38:290–296
Boozari B, Soudah B, Rifai K, Schneidewind S, Vogel A, Hecker H, Hahn A, Schlue J, Dietrich CF, Bahr MJ, Kubicka S, Manns MP, Gebel M (2011) Grading of hypervascular hepatocellular carcinoma using late phase of contrast enhanced sonography—a prospective study. Dig Liver Dis 43(6):484–490
Brancatelli G, Baron RL, Peterson MS et al (2003) Helical CT screening for hepatocellular carcinoma in patients with cirrhosis: frequency and causes of false-positive interpretation. AJR Am J Roentgenol 180:1007–1014
Bruegel M, Holzapfel K, Gaa J et al (2008) Characterization of focal liver lesions by ADC measurements using a respiratory triggered diffusion-weighted single-shot echo-planar MR imaging technique. Eur Radiol 18:477–485
Burrel M, Llovet JM, Ayuso C et al (2003) MRI angiography is superior to helical CT for detection of HCC prior to liver transplantation: an explant correlation. Hepatology 38:1034–1042
Dietrich CF, Potthoff A, Helmberger T, Ignee A, Willmann JK, CEUS LI-RADS Working Group (2018) Contrast-enhanced ultrasound: liver imaging reporting and data system (CEUS LI-RADS). Z Gastroenterol 56(5):499–506
Gillmore R, Stuart S, Kirkwood A et al (2011) EASL and mRECIST responses are independent prognostic factors for survival in hepatocellular cancer patients treated with transarterial embolization. J Hepatol 55:1309–1316
Grazioli L, Olivetti L, Fugazzola C et al (1999) The pseudocapsule in hepatocellular carcinoma: correlation between dynamic MR imaging and pathology. Eur Radiol 9:62–67
Greten TF, Malek NP, Schmidt S, Arends J, Bartenstein P, Bechstein W, Bernatik T et al (2013) Diagnosis of and therapy for hepatocellular carcinoma. Z Gastroenterol 51:1269–1326
Hanna RF, Aguirre DA, Kased N et al (2008) Cirrhosis-associated hepatocellular nodules: correlation of histopathologic and MR imaging features. Radiographics 28:747–769
Holland AE, Hecht EM, Hahn WY et al (2005) Importance of small (〈 or = 20-mm) enhancing lesions seen only during the hepatic arterial phase at MR imaging of the cirrhotic liver: evaluation and comparison with whole explanted liver. Radiology 237:938–944
https://www.acr.org/Clinical-Resources/Reporting-and-Data-Systems/LI-RADS/CT-MRI-LI-RADS-v2018. Zugegriffen: 31.07.2018
Hwang GJ, Kim MJ, Yoo HS et al (1997) Nodular hepatocellular carcinomas: detection with arterial-, portal-, and delayed-phase images at spiral CT. Radiology 202:383–388
Hyodo T, Murakami T, Imai Y et al (2013) Hypovascular nodules in patients with chronic liver disease: risk factors for development of hypervascular hepatocellular carcinoma. Radiology 266:480–490
Kadoya M, Matsui O, Takashima T et al (1992) Hepatocellular carcinoma: correlation of MR imaging and histopathologic findings. Radiology 183:819–825
Kang BK, Lim JH, Kim SH et al (2003) Preoperative depiction of hepatocellular carcinoma: ferumoxides-enhanced MR imaging versus triple-phase helical CT. Radiology 226:79–85
Kim JE, Kim SH, Lee SJ et al (2011) Hypervascular hepatocellular carcinoma 1 cm or smaller in patients with chronic liver disease: characterization with gadoxetic acid-enhanced MRI that includes diffusion-weighted imaging. AJR Am J Roentgenol 196:W758–W765
Kim JI, Lee JM, Choi JY et al (2008) The value of gadobenate dimeglumine-enhanced delayed phase MR imaging for characterization of hepatocellular nodules in the cirrhotic liver. Invest Radiol 43:202–210
Kim YK, Kim CS, Han YM et al (2009) Detection of hepatocellular carcinoma: gadoxetic acid-enhanced 3‑dimensional magnetic resonance imaging versus multi-detector row computed tomography. J Comput Assist Tomogr 33:844–850
Kim YK, Lee WJ, Park MJ et al (2012) Hypovascular hypointense nodules on hepatobiliary phase gadoxetic acid-enhanced MR images in patients with cirrhosis: potential of DW imaging in predicting progression to hypervascular HCC. Radiology 265:104–114
Kircher A, Bongartz G, Merkle EM, Zech CJ (2014) Rational imaging of hepatocellular carcinoma. The challenge of multimodal diagnostic criteria. Radiologe 54(7):664–672
Kono Y, Lyshchik A, Cosgrove D et al (2017) Contrast enhanced ultrasound (CEUS) liver imaging reporting and data system (LI-RADS[R]): the official version by the American College of Radiology (ACR). Ultraschall Med 38:85–86
De Ledinghen V, Laharie D, Lecesne R et al (2002) Detection of nodules in liver cirrhosis: spiral computed tomography or magnetic resonance imaging? A prospective study of 88 nodules in 34 patients. Eur J Gastroenterol Hepatol 14:159–165
Lee JY, Kim SH, Jeon YH et al (2010) Ferucarbotran-enhanced magnetic resonance imaging versus gadoxetic acid-enhanced magnetic resonance imaging for the preoperative detection of hepatocellular carcinoma: initial experience. J Comput Assist Tomogr 34:127–134
Lencioni R, Llovet JM (2010) Modified RECIST (mRECIST) assessment for hepatocellular carcinoma. Semin Liver Dis 30:52–60
Luca A, Caruso S, Milazzo M et al (2010) 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 20:898–907
Marti-Bonmati L (1997) MR imaging characteristics of hepatic tumors. Eur Radiol 7:249–258
Matsui O (2004) Imaging of multistep human hepatocarcinogenesis by CT during intra-arterial contrast injection. Intervirology 47:271–276
Motosugi U, Ichikawa T, Sou H et al (2010) Distinguishing hypervascular pseudolesions of the liver from hypervascular hepatocellular carcinomas with gadoxetic acid-enhanced MR imaging. Radiology 256:151–158
Muhi A, Ichikawa T, Motosugi U et al (2009) High-b-value diffusion-weighted MR imaging of hepatocellular lesions: estimation of grade of malignancy of hepatocellular carcinoma. J Magn Reson Imaging 30:1005–1011
Nishie A, Tajima T, Asayama Y et al (2011) Diagnostic performance of apparent diffusion coefficient for predicting histological grade of hepatocellular carcinoma. Eur J Radiol 80:e29–33
Onaya H, Itai Y (2000) MR imaging of hepatocellular carcinoma. Magn Reson Imaging Clin N Am 8:757–768
Palmer DH, Cheng AL et al (2017) mRECIST to predict survival in advanced hepatocellular carcinoma: analysis of two randomised phase II trials comparing nintedanib vs sorafenib. Liver Int 37:1047–1055
Park MJ, Kim YK, Lee MW et al (2012) Small hepatocellular carcinomas: improved sensitivity by combining gadoxetic acid-enhanced and diffusion-weighted MR imaging patterns. Radiology 264:761–770
Park MJ, Kim YK, Lee MH et al (2013) Validation of diagnostic criteria using gadoxetic acid-enhanced and diffusion-weighted MR imaging for small hepatocellular carcinoma (〈= 2.0 cm) in patients with hepatitis-induced liver cirrhosis. Acta radiol 54:127–136
Reimer P, Schneider G, Schima W (2004) Hepatobiliary contrast agents for contrast-enhanced MRI of the liver: properties, clinical development and applications. Eur Radiol 14:559–578
Rode A, Bancel B, Douek P et al (2001) Small nodule detection in cirrhotic livers: evaluation with US, spiral CT, and MRI and correlation with pathologic examination of explanted liver. J Comput Assist Tomogr 25:327–336
Rofsky NM, Lee VS, Laub G et al (1999) Abdominal MR imaging with a volumetric interpolated breath-hold examination. Radiology 212:876–884
Saito K, Kotake F, Ito N et al (2005) Gd-EOB-DTPA enhanced MRI for hepatocellular carcinoma: quantitative evaluation of tumor enhancement in hepatobiliary phase. Magn Reson Med Sci 4:1–9
Seitz K, Milestone SDA (2016) Approval of CEUS for diagnostic liver imaging in adults and children in the USA. Ultraschall Med 37:229–232
Semaan S, Makkar J, Lewis S et al (2017) Imaging of hepatocellular carcinoma response after (90)Y radioembolization. AJR Am J Roentgenol 209:W263–W276
Shim JH, Lee HC, Kim SO et al (2012) Which response criteria best help predict survival of patients with hepatocellular carcinoma following chemoembolization? A validation study of old and new models. Radiology 262:708–718
Shinmura R, Matsui O, Kobayashi S et al (2005) Cirrhotic nodules: association between MR imaging signal intensity and intranodular blood supply. Radiology 237:512–519
Stoker J, Romijn MG, De Man RA et al (2002) Prospective comparative study of spiral computer tomography and magnetic resonance imaging for detection of hepatocellular carcinoma. Gut 51:105–107
Strobel D, Kleinecke C, Hansler J et al (2005) Contrast-enhanced sonography for the characterisation of hepatocellular carcinomas: correlation with histological differentiation. Ultraschall Med 26:270–276
Strobel D, Seitz K, Blank W, Schuler A, Dietrich C, von Herbay A, Friedrich-Rust M et al (2008) Contrast-enhanced ultrasound for the characterization of focal liver lesions—diagnostic accuracy in clinical practice (DEGUM multicenter trial). Ultraschall Med 29:499–505
Taouli B, Vilgrain V, Dumont E et al (2003) Evaluation of liver diffusion isotropy and characterization of focal hepatic lesions with two single-shot echo-planar MR imaging sequences: prospective study in 66 patients. Radiology 226:71–78
Vincenzi B, Di Maio M, Silletta M et al (2015) Prognostic relevance of objective response according to EASL criteria and mRECIST criteria in hepatocellular carcinoma patients treated with loco-regional therapies: a literature-based Meta-analysis. PLoS ONE 10:e133488
Vogl TJ, Stupavsky A, Pegios W et al (1997) Hepatocellular carcinoma: evaluation with dynamic and static gadobenate dimeglumine-enhanced MR imaging and histopathologic correlation. Radiology 205:721–728
Xu PJ, Yan FH, Wang JH et al (2010) Contribution of diffusion-weighted magnetic resonance imaging in the characterization of hepatocellular carcinomas and dysplastic nodules in cirrhotic liver. J Comput Assist Tomogr 34:506–512
Zech CJ, Herrmann KA, Huber A et al (2004) High-resolution MR-imaging of the liver with T2-weighted sequences using integrated parallel imaging: comparison of prospective motion correction and respiratory triggering. J Magn Reson Imaging 20:443–450
Zech CJ, Schoenberg SO, Herrmann KA et al (2004) Modern visualization of the liver with MRT. Current trends and future perspectives. Radiologe 44:1160–1169
Zech CJ, Herrmann KA, Reiser MF et al (2007) MR imaging in patients with suspected liver metastases: value of liver-specific contrast agent Gd-EOB-DTPA. Magn Reson Med Sci 6:43–52
Zech CJ, Grazioli L, Breuer J et al (2008) Diagnostic performance and description of morphological features of focal nodular hyperplasia in Gd-EOB-DTPA-enhanced liver magnetic resonance imaging: results of a multicenter trial. Invest Radiol 43:504–511
Zech CJ, Herrmann KA, Dietrich O et al (2008) Black-blood diffusion-weighted EPI acquisition of the liver with parallel imaging: comparison with a standard T2-weighted sequence for detection of focal liver lesions. Invest Radiol 43:261–266
Zech CJ, Vos B, Nordell A et al (2009) Vascular enhancement in early dynamic liver MR imaging in an animal model: comparison of two injection regimen and two different doses Gd-EOB-DTPA (gadoxetic acid) with standard Gd-DTPA. Invest Radiol 44:305–310
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C.J. Zech und J. Ricke weisen auf folgende Interessenkonflikte hin: C.J. Zech – Advisory Board und Vortragshonorare von Bayer Healthcare; J. Ricke Research grant und Advisory board Bayer healthcare. A. Potthoff gibt an, dass kein Interessenkonflikt besteht.
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Zech, C.J., Potthoff, A. & Ricke, J. Bildgebende radiologische Diagnostik und Verlaufsbeurteilung beim HCC. Onkologe 24, 680–691 (2018). https://doi.org/10.1007/s00761-018-0435-7
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DOI: https://doi.org/10.1007/s00761-018-0435-7