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Coarse Nodular US Pattern in Hepatic Cirrhosis: Risk for Hepatocellular Carcinoma¹

¹ From the Department of Anatomy and Histopathology, Gastroenterology Unit, Ospedale Casa Sollievo della Sofferenza, San Giovanni Rotondo, Italy (E.C., S.F., G.A.N., A.A.); and Department of Internal Medicine and Gastroenterology, II Università, Naples, Italy (L.C., B.P., C.d.V.B., I.d.S.). Received October 24, 2001; revision requested January 14, 2002; final revision received July 8; accepted July 31. Address correspondence to E.C., Gastroenterology Unit, Ospedale Belcolle, Strada Sammartinese, 01100 Viterbo, Italy (e-mail: e.caturelli@tiscalinet.it).

PURPOSE: To determine the prevalence of the coarse nodular ultrasonographic (US) pattern and its prognostic importance in terms of hepatocellular carcinoma (HCC) risk in hepatic cirrhosis caused by hepatitis B virus (HBV); HBV with hepatitis D virus (HDV), formerly known as hepatitis delta virus; hepatitis C virus (HCV); and alcoholic cirrhosis (ALC) or primary biliary disease (primary biliary cirrhosis [PBC]).

MATERIALS AND METHODS: Four hundred two cases of hepatic cirrhosis caused by HBV (94 patients), HDV (100 patients), HCV (100 patients), ALC (63 patients), or PBC (45 patients) were retrospectively reviewed to identify the US pattern present at diagnosis and its possible association with the cause of the disease and subsequent development of HCC during a mean follow-up of 43.9 months ± 29.9 (SD). Data were analyzed with the ², Fisher exact, and log-rank tests and with the Kaplan-Meier method (all two-tailed).

RESULTS: The coarse nodular pattern was found in a significantly higher percentage of patients with HDV-related cirrhosis (51%) compared with those with HBV (9%), HCV (9%), ALC (11%), or PBC (9%) (P < .001). This pattern was associated with a significantly increased risk for HCC in patients with cirrhosis and HBV-, HCV-, and ALC-related disease but not in those with HDV-related disease and PBC.

CONCLUSION: The coarse nodular pattern is more often seen in patients with HDV-related cirrhosis, and, in this setting (in contrast to HBV-, HCV-, and ALC-related cirrhosis, as well as in PBC), it does not represent an added risk factor for HCC.

© RSNA, 2003

Index terms: Liver, cirrhosis, 761.794 • Liver, US, 761.1298 • Liver neoplasms, 761.323

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				M. Barone, G. A. Niro, S. Fusilli, I. de Sio, and E. Caturelli Hepatitis D-related Cirrhosis and Risk of Hepatocellular Carinoma Development * Dr Niro and colleagues respond: Radiology, October 1, 2004; 233(1): 299 - 300. [Full Text] [PDF]