Duplex-Doppler ultrasonography is a non-invasive method and can be used for early evaluation of the hepatic focal lesions and diagnosis of HCC.
Hepatocellular carcinoma (HCC) is the fifth most common cancer and the third leading cause of cancer death worldwide .
Hepatocellular carcinoma is usually asymptomatic in the early stages and tends to be intravascularly and intrabiliary invasive. Therefore, most patients are presented with an incurable disease at the time of detection which makes early diagnosis of HCC critical for a good prognosis .
The spectrum of hepatic focal lesions in patients with chronic liver disease ranges from frankly benign to overtly malignant, from the stage of regenerating nodules to adenomatous hyperplasia, atypical adenomatous hyperplasia, early HCC, advanced HCC in a multistep fashion with increasing degree of malignancy.
At present, Alpha fetoprotein (AFP) is the most commonly used tumor marker in early HCC screening in populations at high risk however AFP levels may be normal in up to 40% of patients, particularly during the early stages (low sensitivity), Thus, the clinical value of AFP has been questioned due to its low sensitivity and specificity.
Thus, the diagnosis of HCC must rest on radiological appearances .
NO single diagnostic modality yields diagnostic accuracy consistently over 50% to 60% in detecting lesions less than 1 cm, a time when curative surgery is most likely. Therefore, screening with AFP, ultrasonography, duplex-doppler U/Sand judicious use of CT provide the best hope for early diagnosis .
The great practical advantage of Duplex system is simultaneous display of blood flow spectrum and of the anatomy from which it derives duplex Doppler ultrasound has come to play a central role in the diagnosis of HCC.
Three-dimensional C.T images provide more precise diagnosis information and a realistic virtual image of a tumor's location in the liver. It was found that three-dimensional CT was 100% accurate in localizing tumors, whereas conventional C.T was 75% accurate.
The aim was to compare between duplex-Doppler U/S results and AFP & results of triphasic CT to evaluate the sensitivity & specificity of Doppler U/S in characterization of HCC.
100 patients with HCC were prospectively enrolled in this study In our study , Triphasic CT was done for 100 hepatic focal lesions ,79 HFL show the characteristic HCC features.
Duplex –doppler ultrasonography was done for 100 hepatic focal lesions, 2 malignant HFL showing no signals,while 18 benign HFL showing no flow.
55 malignant HFL showing arterial flow ,while 1 benign HFL only showing arterial flow . 10 malignant HFLshowing venous flow ,while 1 benign HFL showing venous flow. 10 malignant HFL showing arterio-venous flow ,while 1 benign HFL showing arterio-venous flow.There is arterio-portal shunting in 41 malignant HFL ,while no arterioportal shunting in benign HFL.
The mean peak systolic frequency shift for malignant HFL mean ± SD is 1.9 ,while for benign HFL is 0.6.
Best cutoff of the mean peak systolic frequency shift point which differentiate between HCC and benign focal lesion was 0.85 at which sensitivity and specificity were 82% & 71.4 respectively.
AFP Best cutoff point which differentiate between HCC and benign focal lesion was 112 at which sensitivity and specificity were 70% & 76.2 respectively.
Arterial flow signal of the HFL by duplex-doppler U/S: Sensitivity:70%&Specificity:95.2% inside flow signal of the HFL by duplex-doppler U/S: Sensitivity:83.5%&Specificity:95.2% Arterioportal shunting of the HFL: Sensitivity:52% &Specificity:100%.
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