title: Preoperative evaluation of hepatocellular carcinoma: combined use of CT with arterial portography and hepatic arteriography.
abstract: OBJECTIVE
  This study was undertaken to determine the usefulness of combined CT during arterial portography and CT hepatic arteriography in the preoperative evaluation of patients with known or suspected hepatocellular carcinoma and to describe the findings on CT during arterial portography and CT hepatic arteriography by which hepatocellular carcinomas may be differentiated from pseudolesions.
  
  
  METHODS
  This study included 137 patients who underwent combined CT during arterial portography and CT hepatic arteriography for the preoperative evaluation of known or suspected hepatocellular carcinoma. The images were prospectively evaluated to identify focal hepatic lesions and their differential diagnoses (hepatocellular carcinoma versus pseudolesion). We assessed the diagnostic accuracy of our prospective interpretation by comparing the interpretations with the results of histopathology or follow-up imaging. We also retrospectively analyzed imaging features seen on CT during arterial portography and CT hepatic arteriography-the size, shape, and location of the lesion within the liver; attenuation of the lesion; and opacification of the peripheral portal vein branches on CT hepatic arteriography.
  
  
  RESULTS
  One hundred and forty-nine hepatocellular carcinomas (75 lesions confirmed at histopathology and 74 lesions on follow-up imaging) were found in 120 patients, and 104 pseudolesions (15 lesions confirmed at histopathology and 89 lesions on follow-up imaging) were found in 91 patients. The sensitivity of our prospective interpretations was 98.7%, and the specificity of our prospective interpretations was 90.4%. Our positive and negative predictive values were 93.6% and 97.9%, respectively. We found that hepatocellular carcinomas were larger, more frequently nodular, and more likely to be located intraparenchymally than were the pseudolesions (p < 0.01). Opacification of the peripheral portal vein branches on CT hepatic arteriography was detected in 36 pseudolesions (34.6%) but in none of the hepatocellular carcinomas (p < 0.01).
  
  
  CONCLUSIONS
  Combining CT during arterial portography and CT hepatic arteriography is useful for the preoperative evaluation of patients with known or suspected hepatocellular carcinoma. Familiarity with the imaging features of hepatocellular carcinomas and pseudolesions can help in the accurate differentiation of hepatocellular carcinomas from pseudolesions.
authors.affiliation: Department of Radiology, Asan Medical Center, University of Ulsan, 388-1 Poongnap-Dong, Songpa-Ku, Seoul, 138-736, Korea.
authors.forename: Hyun Cheol
authors.initials: HC
authors.lastname: Kim
authors.forename: Tae Kyoung
authors.initials: TK
authors.lastname: Kim
authors.forename: Kyu-Bo
authors.initials: KB
authors.lastname: Sung
authors.forename: Hyun-Ki
authors.initials: HK
authors.lastname: Yoon
authors.forename: Pyo Nyun
authors.initials: PN
authors.lastname: Kim
authors.forename: Hyun Kwon
authors.initials: HK
authors.lastname: Ha
authors.forename: Ah Young
authors.initials: AY
authors.lastname: Kim
authors.forename: Hyun Jin
authors.initials: HJ
authors.lastname: Kim
authors.forename: Moon-Gyu
authors.initials: MG
authors.lastname: Lee
mesh_terms: D000328:Adult; D000368:Aged; D000792:Angiography; D006528:Carcinoma, Hepatocellular / Q000000981:diagnostic imaging* / Q000601:surgery*; D003937:Diagnosis, Differential; D005260:Female; D006499:Hepatic Artery / Q000000981:diagnostic imaging*; D006801:Humans; D008107:Liver Diseases / Q000000981:diagnostic imaging* / Q000601:surgery*; D008113:Liver Neoplasms / Q000000981:diagnostic imaging* / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D011172:Portography; D011300:Preoperative Care; D011446:Prospective Studies; D015203:Reproducibility of Results; D012680:Sensitivity and Specificity; D012720:Severity of Illness Index; D014057:Tomography, X-Ray Computed