title: Detection of primary hepatic malignancy in liver transplant candidates: prospective comparison of CT, MR imaging, US, and PET.
abstract: OBJECTIVE
  To determine and compare the diagnostic performance of computed tomography (CT), magnetic resonance (MR) imaging, ultrasonography (US), and positron emission tomography (PET) in the detection of hepatocellular carcinoma (HCC) or cholangiocarcinoma in liver transplant candidates and to determine interobserver variability between the readers.
  
  
  METHODS
  Twenty-five patients were examined prospectively with CT, MR imaging, US, and PET. Each test result was interpreted independently by two radiologists. Explanted liver specimens were examined histologically to determine presence and type of lesion. Results were analyzed on a patient-by-patient basis with marginal homogeneity and effect likelihood ratio tests.
  
  
  RESULTS
  HCC was diagnosed in nine patients. US diagnostic performance was superior to that of CT and MR imaging on a patient-by-patient basis. Sensitivities were higher for US (0.89 for both US readers) than they were for CT (0.67 and 0.56 for readers 1 and 2, respectively), MR imaging (0.56 and 0.50 for readers 1 and 2, respectively), and PET (0 for both readers). None of the differences (within test) between readers were significant (P >or=.32). Ratings by US and MR observers and one CT observer were significantly associated with truth (P <or=.04). One or more imaging tests depicted 68 lesions. Histologic analysis revealed 18 HCC nodules; of these, 13 were correctly identified at CT, 14 at MR imaging, 13 at US, and none at PET. There were nine false-positive diagnoses of HCC with CT, five with MR imaging, and nine with US.
  
  
  CONCLUSIONS
  Although US had the best diagnostic performance in depicting HCC on a patient-by-patient basis and was substantially better than were MR imaging and CT (which had nearly equivalent diagnostic performances), CT, US, and MR imaging performed similarly on a lesion-by-lesion basis. Small tumor nodules were the most common cause of missed HCCs with all tests. PET did not depict any HCCs.
authors.affiliation: Mallinckrodt Institute of Radiology, Washington University School of Medicine, 510 S Kingshighway Blvd, St Louis, MO 63110, USA. teefeys@mir.wustl.edu
authors.forename: Sharlene A
authors.initials: SA
authors.lastname: Teefey
authors.forename: Charles C
authors.initials: CC
authors.lastname: Hildeboldt
authors.forename: Farrokh
authors.initials: F
authors.lastname: Dehdashti
authors.forename: Barry A
authors.initials: BA
authors.lastname: Siegel
authors.forename: Marion G
authors.initials: MG
authors.lastname: Peters
authors.forename: Jay P
authors.initials: JP
authors.lastname: Heiken
authors.forename: Jeffrey J
authors.initials: JJ
authors.lastname: Brown
authors.forename: Elizabeth G
authors.initials: EG
authors.lastname: McFarland
authors.forename: William D
authors.initials: WD
authors.lastname: Middleton
authors.forename: Dennis M
authors.initials: DM
authors.lastname: Balfe
authors.forename: Jon H
authors.initials: JH
authors.lastname: Ritter
mesh_terms: D000328:Adult; D000368:Aged; D001650:Bile Duct Neoplasms / Q000175:diagnosis* / Q000000981:diagnostic imaging / Q000473:pathology; D001653:Bile Ducts, Intrahepatic; D006528:Carcinoma, Hepatocellular / Q000175:diagnosis* / Q000000981:diagnostic imaging / Q000473:pathology; D018281:Cholangiocarcinoma / Q000175:diagnosis* / Q000000981:diagnostic imaging / Q000473:pathology; D003952:Diagnostic Imaging; D005260:Female; D006801:Humans; D008113:Liver Neoplasms / Q000175:diagnosis* / Q000000981:diagnostic imaging / Q000473:pathology; D016031:Liver Transplantation; D016015:Logistic Models; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D012372:ROC Curve; D012680:Sensitivity and Specificity; D014055:Tomography, Emission-Computed; D014057:Tomography, X-Ray Computed; D018615:Ultrasonography, Doppler, Color