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

Abstract To evaluate the diagnostic performance of CT, MRI, and CEUS alone and in combination, for the diagnosis of HCC between 10 and 30 mm, in a large population of cirrhotic patients. In a multicentre prospective trial, 442 patients have been enrolled. Within a month CEUS, CT and MRI were performed for all patients. A composite algorithm was defined to obtain the more accurate gold standard. 544 nodules in 381 patients have been retained for the performance analysis. Patients were 82% of male, mean age was 62 years. For the 10-20mm nodules (n=342), the sensitivity (Se) and specificity (Sp) for the diagnosis of HCC were respectively 70.6% and 83.2% for MRI, 67.9% and 76.8% for CT, and 39.6% and 92.9% for CEUS. For the 20-30mm nodules (n=202), the Se and Sp were respectively 72.3% and 89.4% for MRI, 71.6% and 93.6% for CT and 52.9% and 91.5% for CEUS. The best combination for the 10-20mm nodules was MR + CT (Se: 55.1%, Sp: 100.0%) After a first inconclusive technique, CEUS as second image technique allowed the highest specificity with only a slight drop of sensitivity for 10-20mm nodules and the highest sensitivity and specificity for 20-30mm nodules. This large multicentre study validates the EASL/AASLD recommendations in daily practice. Specificity using CT or MRI in 10-20mm HCC was low, but we do not recommend combined imaging at first as sensitivity would be very low. The best sequential approach combined MRI and CEUS. This article is protected by copyright. All rights reserved.