Accuracy of multiphasic helical computed tomography and intraoperative sonography in patients undergoing orthotopic liver transplantation for hepatoma: what is the truth?
OBJECTIVE
To determine the real value of liver imaging in cirrhosis by macro- and histomorphologic examination of the entire organ after orthotopic liver transplantation for hepatocellular carcinoma (HCC).


BACKGROUND
In comparative studies, a virtual sensitivity of up to 94% is described for helical computed tomography in HCC staging. The tumor detection rate of intraoperative ultrasonography (IOUS) is reported to be almost 100%.


METHODS
This prospective observational study comprised 23 patients with HCC in cirrhosis admitted for orthotopic liver transplantation. Results of preoperative triphasic helical computed tomography (HCT) and IOUS were correlated with histopathologic results after 3-mm-slicing of the explanted liver.


RESULTS
Overall, 179 liver segments were examined by HCT, IOUS, and MHM. Fifty-two malignant lesions and 10 dysplastic nodules were revealed by MHM. Using HCT, 13 HCCs could not be identified in 8 patients and 15 results were falsely positive in 10 patients. The detection rate of dysplastic nodes was 40% for HCT and 60% for IOUS. IOUS missed four HCCs in four patients and had six false-positive results in six patients. In a segment-based analysis, the overall accuracy of IOUS was significantly higher for IOUS (95.5%) versus HCT (89.9%). In the lesion-by-lesion analysis, the sensitivity was 92.3% for IOUS and 75.0% for HCT, with a significant difference.


CONCLUSIONS
Correlation of explanted liver pathologic results offers precise evaluation of imaging modalities. The data of this histopathologically based study confirm that IOUS is significantly superior in staging HCC in cirrhosis versus CT, even after technical refinements through enhanced multiphasic high-velocity helical scanning.
Zacherl
Johannes
J
Department of Surgery, Division of General Surgery, Universität Wien, Vienna, Austria. johannes.zacherl@akh-wien.ac.at
Pokieser
Peter
P
Wrba
Fritz
F
Scheuba
Christian
C
Prokesch
Rupert
R
Zacherl
Maximilian
M
Längle
Friedrich
F
Berlakovich
Gabriela A
GA
Mühlbacher
Ferdinand
F
Steininger
Rudolf
R
D000328:Adult; D000368:Aged; D006528:Carcinoma, Hepatocellular / Q000000981:diagnostic imaging* / Q000601:surgery; D005260:Female; D006801:Humans; D007430:Intraoperative Care; D008103:Liver Cirrhosis / Q000000981:diagnostic imaging* / Q000601:surgery; D008113:Liver Neoplasms / Q000000981:diagnostic imaging* / Q000601:surgery; D016031:Liver Transplantation / Q000000981:diagnostic imaging*; D008297:Male; D008875:Middle Aged; D009098:Multiphasic Screening; D009367:Neoplasm Staging; D011237:Predictive Value of Tests; D012680:Sensitivity and Specificity; D014057:Tomography, X-Ray Computed; D014463:Ultrasonography