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AHRQ--Agency for Healthcare Research and Quality: Advancing Excellence in Health Care

Topic Suggestion Description

View Topic Suggestion Disposition (PDF) 135 kB

Date submitted: September 09, 2011

Briefly describe a specific question, or set of related questions, about a health care test or treatment that this program should consider.
Comparative effectiveness of ultrasound, conventional computed tomography (CT), multidetector computed tomography (MDCT), magnetic resonance imaging (MRI) (using conventional VS novel contrast agents) for the primary diagnosis and staging of hepatocellular carcinoma
Which is the best imaging test to diagnose liver cancer and tell how advanced it is or how widely it has spread?
Does your question include a comparison of different health care approaches? (If no, your topic will still be considered.)
If yes, explain the specific technologies, devices, drugs, or interventions you would like to see compared:
conventional CT, MDCT, MRI (using conventional VS novel contrast agents)
What patients or group(s) of patients does your question apply to? (Please include specific details such as age range, gender, coexisting diagnoses, and indications for therapy.)
Population at high risk for hepatocellular carcinoma, and patients diagnosed with hepatocellular carcinoma who require staging
Are there subgroups of patients that your question might apply to? (For example, an ethnic group, stage or severity of a disease.)
Patients with hepatitis viral infections and cirrhosis
Describe the health-related benefits you are interested in. (For example, improvements in patient symptoms or problems from treatment or diagnosis.)
Improvements in morbidity and mortality of hepatocellular carcinoma due to early diagnosis

Improvements in the accuracy of staging among patients with hepatocellular carcinoma, which may assist treatment decisions and prognosis
Describe any health-related risks, side effects, or harms that you are concerned about.
In patients at risk of hepatocellular carcinoma:
Harm caused by false positives (such as unnecessary biopsies, increased medical cost, increased stress due to medical diagnoses and treatments), under-diagnosis resulting in failure to achieve early diagnosis and early intervention

In patients diagnosed with hepatocellular carcinoma:
Risk of missed metastases diagnosis, errors in pre-therapy staging, errors in staging decisions that may cause unnecessary medical treatments and stress

Appropriateness for EHC Program

Does your question include a health care drug, intervention, device, or technology available (or likely to be available) in the U.S.?
Which priority area(s) and population(s) does this topic apply to? (check all that apply)
EHC Priority Conditions (updated in 2008)
  • Cancer
  • Infectious diseases, including HIV/AIDS
  • Substance abuse
AHRQ Priority Populations
  • Minority groups
Federal Health Care Program
  • Medicaid
  • Medicare


Describe why this topic is important.
Hepatocellular carcinoma is the fifth most common tumor in the world. Its incidence is expected to increase due to increased incidence of hepatitis viral infections and cirrhosis. Early diagnosis and accurate staging of this cancer is important for informing treatment decisions and improving prognosis.
Imaging modalities evaluates vascular and cellular information and may assist diagnosis and staging of hepatocellular carcinoma. For example, unenhanced and dynamic-enhanced CT and MRI with tissue-specific contrast agents, including superparamagnetic iron oxides and hepatobiliary contrast agents, improve lesion detection and characterization. However, a formal comparison among these imaging modalities is yet to be performed.
What specifically motivated you to ask this question? (For example, you are developing a clinical guideline, working with a policy with large uncertainty about the appropriate approach, costly intervention, new research you have read, items in the media you may have seen, a clinical practice dilemma you know of, etc.)
This topic was recommended by a diverse panel of stakeholders as a high priority question for an evidence review.
Does your question represent uncertainty for clinicians and/or policy-makers? (For example, variations in clinical care, controversy in what constitutes appropriate clinical care, or a policy decision.)
If yes, please explain:
A variety of imaging modalities evaluates vascular and cellular information and may assist diagnosis and staging of hepatocellular carcinoma. However, a formal comparison among these imaging modalities is yet to be performed.

Potential Impact

How will an answer to your research question be used or help inform decisions for you or your group?
The answer(s) to this research question will be disseminated by the Effective Health Care Program to clinical providers and policy makers who will be able to use this information to make more informed treatment recommendations and coverage decisions.
Describe the timeframe in which an answer to your question is needed.
As soon as possible, in order to benefit as many patients as possible
Describe any health disparities, inequities, or impact on vulnerable populations your question applies to.
The risk of hepatocellular carcinoma affects the general US population, men and women. It includes many individuals representative of both vulnerable populations and those unequally screened for diagnosis.

Nominator Information

Other Information About You: (optional)
Please choose a description that best describes your role or perspective: (you may select more than one category if appropriate)
  • Other
Are you making a suggestion as an individual or on behalf of an organization?
Organization - Tufts EPC
Please tell us how you heard about the Effective Health Care Program