1. In patients with suspected cirrhosis, which imaging tool is more sensitive and/or specific--CT or MRI?
***Source: Pubmed
Identified two systematic reviews of studies comparing imaging tools - both reviews focused on studies evaluating efficacy in diagnosing hepatocellular carcinoma.
Accuracy of ultrasonography, spiral CT, magnetic resonance, and alpha-fetoprotein in diagnosing hepatocellular carcinoma: a systematic review. Am J Gastroenterol. 2006 Mar;101(3):513-23
Review: MRI is more sensitive but less specific than ultrasonography or spiral CT for diagnosis of hepatocellular carcinoma.ACP J Club. 2006 Jul-Aug;145(1):21.
2. In diagnosing hemachromatosis, how do the various tests (ferritin, % saturation, genetics test) compare in terms of sensitivity and specificity. Is there a gold standard?
***Source: UptoDate - searched hemochromatosis
Clinical Guideline for diagnosing hereditary hemochromatosis - from the American Association for the Study of Liver Diseases. Tavill, AS, Hepatology 2001; 33:1321.
***Source: Pubmed
Study/Review - Type of assessment - Sensitivity - Specifity
Baynes (1988) - UIBC - 77% - 95%
Bryant (2008, pooled data from 11 studies) - genetic - 91.8% - NA
Adams (2006, validation study) - serum ferriten and transerrin saturation - means for both were statistically significantly higher in homozygotes than in other genotypes
Liver biopsy is considered the definitive tool for measuring extent of iron overload; however may not be necessary in all cases as documented in the AASLD guideline cited above.
