Pretransplantation evaluation of the cirrhotic liver with explantation correlation: accuracy of CT arterioportography and digital subtraction hepatic angiography in revealing hepatocellular carcinoma.
OBJECTIVE
The aim of this study was to determine the accuracy of CT arterioportography and hepatic digital subtraction angiography, separately and combined, for the detection of hepatocellular carcinoma in the cirrhotic liver by using thin-section liver explant histopathologic findings.


METHODS
Fifty-nine patients with liver cirrhosis were examined with CT arterioportography and digital subtraction angiography as a part of preoperative diagnostic workup for liver transplantation. Before liver explantation, CT arterioportograms and digital subtraction angiograms were prospectively evaluated in a blinded manner, separately by two CT radiologists and two angiographers, respectively, and combined by two reviewer teams, each including a CT radiologist and an angiographer. In addition, each examination was retrospectively evaluated using direct comparison with the corresponding thin-section liver explant specimens


RESULTS
There were 39 histologically confirmed hepatocellular carcinomas. In both prospective and retrospective assessments, the reviewers achieved the best performance with CT arterioportography and digital subtraction angiography combined (area under the curve [A(z)] 0.82). The diagnostic confidence in the detection of hepatocellular carcinoma was higher with digital subtraction angiography (A(z), 0.81) than that with CT arterioportography (A(z), 0.68). Prospectively, sensitivity and specificity were 75% and 60% for CT arterioportography, 77% and 80% for digital subtraction angiography, and 84% and 81% for CT arterioportography and digital subtraction angiography combined, respectively. Retrospectively, sensitivity and specificity were 80% and 62% for CT arterioportography; 82% and 79% for digital subtraction angiography; 87% and 81% for CT arterioportography and digital subtraction angiography combined, respectively. Five hepatocellular carcinomas, one poorly and four well differentiated, with a mean size of 1.4 cm were not detectable on the CT arterioportography and digital subtraction angiography combination. False-positive findings were 20, 11, and 10 on CT arterioportography, digital subtraction angiography, and the CT arterioportography and digital subtraction angiography combination.


CONCLUSIONS
Combining CT arterioportography with digital subtraction angiography enabled reliable detectability of moderately and poorly differentiated hepatocellular carcinomas in cirrhotic livers but was less sensitive for the detection of well-differentiated hepatocellular carcinomas and resulted in a relatively high rate of false-positive findings.
Steingruber
Iris E
IE
Department of Radiology, Kurt Amplatz Center, Innsbruck University Hospital, Anichstr. 35, 6020 Innsbruck, Austria.
Mallouhi
Ammar
A
Czermak
Benedikt V
BV
Waldenberger
Peter
P
Gassner
Eva
E
Offner
Felix
F
Chemelli
Andreas
A
Koenigsrainer
Alfred
A
Vogel
Wolfgang
W
Jaschke
Werner R
WR
D015901:Angiography, Digital Subtraction; D006528:Carcinoma, Hepatocellular / Q000150:complications / Q000000981:diagnostic imaging* / Q000601:surgery; D005189:False Positive Reactions; D005260:Female; D006801:Humans; D008099:Liver / Q000473:pathology; D008103:Liver Cirrhosis / Q000150:complications / Q000000981:diagnostic imaging* / Q000601:surgery; D008113:Liver Neoplasms / Q000150:complications / Q000000981:diagnostic imaging* / Q000601:surgery; D016031:Liver Transplantation; D008297:Male; D008875:Middle Aged; D011172:Portography / Q000379:methods; D011300:Preoperative Care; D011446:Prospective Studies; D012372:ROC Curve; D012189:Retrospective Studies; D012680:Sensitivity and Specificity; D014057:Tomography, X-Ray Computed