Diagnosis and screening of small hepatocellular carcinomas. Comparison of radionuclide imaging, ultrasound, computed tomography, hepatic angiography, and alpha 1-fetoprotein assay.
Twenty-nine small (< 5 cm) hepatocellular carcinomas in 18 patients were examined by radionuclide imaging (RN), ultrasound (US), computed tomography (CT), hepatic angiography and serum .alpha.1-fetoprotein (AFP) assay. Sensitivity was 39% with RN, 50% with US, 56% with CT and 94% with angiography, including infusion hepatic angiography (IHA). Lesions > 3 cm could be detected by all of these methods; those between 2-3 cm were generally shown by US and CT but not RN. IHA was essential for diagnosis of lesions < 2 cm, which were otherwise difficult or impossible to detect except with angiography. As a screening method, AFP was best, followed by US and CT. Use of AFP and US to minimize expense and radiation exposure is recommended. In questionable cases, IHA should be performed.