However, because true negative cannot be uniquely defined in a per-nodule

analysis, the specificity changes depending on the authors’ arbitrary definitions; thus, an objective comparison of the superiority is difficult. The sensitivity is higher in a per-patient analysis than in a per-nodule analysis, however, the specificity can be uniquely defined, so that this type of analysis is more appropriate for comparison of the superiority among tests. Recently, a few articles on studies per segment, Selumetinib supplier which is positioned in between the two, have been reported; however, it must be borne in mind that the sensitivity is lower and specificity is higher when this analysis is used than in the per-patient analysis. Unfortunately, the systematic review by Colli et al. cites the sensitivity and specificity based on per-patient analyses, but also includes some per-nodule analyses. The sensitivity of both dynamic CT and dynamic MRI for detection of hypervascular hepatocellular carcinoma s is high. Helical dynamic CT or dynamic BMS-907351 cell line MRI should be used for the diagnosis of hypervascular hepatocellular carcinomas. MRI and CT are at present considered as comparable, although there are some reports suggesting that MRI might be superior. By assuming that hepatocellular carcinoma patients

repeatedly undergo examinations and both techniques may have comparable diagnostic capabilities, dynamic MRI which does not involve X-ray exposure, may be more beneficial. Nonetheless, MRI systems allowing high-quality dynamic studies are not commonly available as compared to high-speed CT systems and not selleck all institutions can perform dynamic MRI. Therefore, there is no other choice but to perform dynamic CT. Dynamic CT and dynamic MRI are difficult to perform in patients with decreased renal function, so that SPIO-MRI may also have a role. Abdominal ultrasonography

does not allow uniform visualization of the entire liver; thus, while the sensitivity is low, it can play a supplemental role because of its high specificity. Gd-EOB-DTPA (gadolinium ethoxybenzyl diethylenetriaminepentaacetic acid), a hepatocellular-specific contrast agent, became available for use in January 2008; it is expected to yield a higher diagnostic performance. CQ10 Is angiography necessary for the detection of small hepatocellular carcinoma nodules? Angiography is not recommended for the diagnosis of hepatocellular carcinoma. (grade D) Based on nine studies performed using explanted livers after liver transplantation and five studies conducted on resected livers (including resection + biopsy, and resection + biopsy + clinical diagnosis) as the gold standards, the diagnostic performance of each diagnostic imaging modality was reviewed by per-lesion and per-segment analyses (Table 1).