title: Accuracy of multiphasic helical computed tomography and intraoperative sonography in patients undergoing orthotopic liver transplantation for hepatoma: what is the truth?
abstract: 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.
authors.affiliation: Department of Surgery, Division of General Surgery, Universität Wien, Vienna, Austria. johannes.zacherl@akh-wien.ac.at
authors.forename: Johannes
authors.initials: J
authors.lastname: Zacherl
authors.forename: Peter
authors.initials: P
authors.lastname: Pokieser
authors.forename: Fritz
authors.initials: F
authors.lastname: Wrba
authors.forename: Christian
authors.initials: C
authors.lastname: Scheuba
authors.forename: Rupert
authors.initials: R
authors.lastname: Prokesch
authors.forename: Maximilian
authors.initials: M
authors.lastname: Zacherl
authors.forename: Friedrich
authors.initials: F
authors.lastname: Längle
authors.forename: Gabriela A
authors.initials: GA
authors.lastname: Berlakovich
authors.forename: Ferdinand
authors.initials: F
authors.lastname: Mühlbacher
authors.forename: Rudolf
authors.initials: R
authors.lastname: Steininger
mesh_terms: 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