Pretransplantation diagnosis and staging of hepatocellular carcinoma in patients with cirrhosis: value of dual-phase helical CT.
OBJECTIVE
The objective of our study was to prospectively evaluate the results of helical CT in the detection of hepatocellular carcinoma (HCC) in patients with cirrhosis undergoing orthotopic liver transplantation. SUBJECTS AND METHODS. Eighty-five patients with cirrhosis were studied preoperatively with biphasic helical CT. Arterial, portal, and equilibrium phase images were obtained after injection of 170 mL of contrast material at 5 mL/sec. The prospective CT interpretation was compared with pathologic results on a lesion-by-lesion basis.


RESULTS
Pathologic examination found 85 cases of HCC in 51 patients. Helical CT enabled a correct diagnosis of HCC in 67 of 85 lesions for a sensitivity of 78.8%. HCC nodules were hypervascular in the arterial phase and hypovascular in the equilibrium phase in 63.5% (54/85) of patients. The false-negative rate was 21% (n = 18), and the positive predictive value was 88%. We had nine false-positive findings (11.8%) related to hemangiomas, transient hepatic attenuation differences, and regenerative nodules. Helical CT detected 61% (23/38) of lesions smaller than 2 cm and 93.6% (44/47) of lesions 2 cm or larger.


CONCLUSIONS
Helical CT is a useful preoperative imaging technique in cirrhotic patients who are candidates for orthotopic liver transplantation, although it is relatively insensitive for detection of small lesions (< 2 cm).
Valls
Carlos
C
Institut de Diagnòstic per la Imatge, Hospital Universitari de Bellvitge, L'Hospitalet de Llobregat, Autovia de Castelldefels, Barcelona 08907, Spain. carlosvalls@csub.scs.es
Cos
Mònica
M
Figueras
Juan
J
Andía
Eduard
E
Ramos
Emilio
E
Sánchez
Anna
A
Serrano
Teresa
T
Torras
Jaume
J
D000328:Adult; D000368:Aged; D006528:Carcinoma, Hepatocellular / Q000150:complications / Q000000981:diagnostic imaging* / Q000473:pathology*; D005260:Female; D006801:Humans; D008103:Liver Cirrhosis / Q000150:complications / Q000000981:diagnostic imaging*; D008113:Liver Neoplasms / Q000150:complications / Q000000981:diagnostic imaging* / Q000473:pathology*; D016031:Liver Transplantation; D008297:Male; D008875:Middle Aged; D009367:Neoplasm Staging; D011237:Predictive Value of Tests; D011300:Preoperative Care; D011446:Prospective Studies; D015203:Reproducibility of Results; D036542:Tomography, Spiral Computed