Radiologic monitoring of hepatocellular carcinoma tumor viability after transhepatic arterial chemoembolization: estimating the accuracy of contrast-enhanced cross-sectional imaging with histopathologic correlation.
OBJECTIVE
Cross-sectional diagnostic imaging studies such as contrast-enhanced quadruple-phase helical computed tomography (CT) and contrast-enhanced magnetic resonance (MR) imaging are routinely performed to evaluate tumor response to transhepatic arterial chemoembolization. However, the true correlation between imaging characteristics and histopathologic tumor viability is not known. The aim of the present retrospective study was to determine the sensitivity and specificity of contrast-enhanced CT and contrast-enhanced MR imaging with use of histopathologic analysis.


METHODS
Between February 2002 and October 2005, a total of 31 patients (age, 51-74 years; mean, 60 y) who had undergone chemoembolization underwent follow-up diagnostic cross-sectional imaging before transplantation. The mean time interval between the imaging study and transplantation was 32 days (range, 1-117 d). Imaging studies were assessed for residual or recurrent tumor and were then correlated to the findings of histopathologic analysis performed on the surgical specimens at the time of transplantation.


RESULTS
The overall sensitivity and specificity rates of cross-sectional imaging studies were 35% and 64%, respectively. The overall accuracy rate of CT was 43%, with 36% sensitivity and 57% specificity. The overall accuracy rate of MR imaging was 55%, with 43% sensitivity and 75% specificity. Gross macroscopic disease was missed in one patient (9%) who underwent MR imaging and four patients (19%) who underwent CT.


CONCLUSIONS
Contrast-enhanced CT and MR imaging after chemoembolization are associated with high error rates. Between the two modalities, MR has higher sensitivity and specificity and may be a preferable imaging tool for patients who have undergone chemoembolization.
Hunt
Stephen J
SJ
Department of Biological Sciences, Stanford University School of Medicine, Stanford, CA 94305, USA.
Yu
Woojin
W
Weintraub
Joshua
J
Prince
Martin R
MR
Kothary
Nishita
N
D000368:Aged; D006528:Carcinoma, Hepatocellular / Q000000981:diagnostic imaging* / Q000473:pathology* / Q000628:therapy; D002470:Cell Survival; D016461:Chemoembolization, Therapeutic; D003287:Contrast Media; D003951:Diagnostic Errors; D005260:Female; D006801:Humans; D007089:Image Enhancement; D007090:Image Interpretation, Computer-Assisted; D008113:Liver Neoplasms / Q000000981:diagnostic imaging* / Q000473:pathology* / Q000628:therapy; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D011237:Predictive Value of Tests; D015203:Reproducibility of Results; D012189:Retrospective Studies; D012680:Sensitivity and Specificity; D013997:Time Factors; D036542:Tomography, Spiral Computed; D016896:Treatment Outcome
D003287:Contrast Media