title: [Diagnostic value of multislice spiral CT and MRI in detection of tumor recurrence after liver transplantation for hepatocellular carcinoma].
abstract: OBJECTIVE
  To investigate the manifestation and diagnostic value of multislice spiral CT (MSCT) and MRI imaging in detection of tumor recurrence after liver transplantation for hepatocellular carcinoma (HCC).
  
  
  METHODS
  The clinical data of 161 consecutive HCC patients who underwent orthotopic liver transplantation were retrospectively reviewed. Twenty-nine HCC patients were classified by pTNM according to the "Pittsburgh criteria". MSCT and MRI findings of tumor recurrence after liver transplantation were evaluated retrospectively in 29 stage II-IVb HCC patients. The recurrence site and relapse interval between liver transplantation and recurrence were analyzed.
  
  
  RESULTS
  Lung tumor recurrence were found in 21 cases, presented as cotton-like lesions in a diameter of 2 - 3 cm, with a clear margin and homogeneous density. Pleural tumor recurrence was detected in 4 cases. Liver tumor recurrence were found in 9 cases, which can be divided into four subtypes: multinodular in 4 cases, diffuse lesion in 2 cases, huge mass in 2 cases, and uninodular in 1 case. Two cases showed tumor thrombus in the inferior vena cava and portal vein. Lymph node tumor recurrence was found in 9 cases, presented as multiple nodules at hepatic hilum, lesser peritoneal sac, posterior mediastinum, retroperitoneum, or around pancreatic head, and accompanied with merging and necrosis in one case. Bone tumor recurrence were found as osteolytic destruction in 4 cases, and accompanied with adjacent soft-tissue mass in 2 cases. The recurrence sites of the 29 cases were as following: lung (21 cases, 72.4%), liver (9 cases, 31.0%), lymph nodes (9 cases, 31.0%), bone (4 cases, 13.8%) and other sites (3 cases, 10.3%). Lung tumor recurrence was found in all the 10 stage IVb patients with tumor recurrence after liver transplantation, significantly more frequent than that in stage IVa patients (P = 0.023). After liver transplantation, all 25 patients with stage III approximately IVb HCC developed recurrence within one year, but in the 4 cases with stage II HCC at one year later (P = 0.009).
  
  
  CONCLUSIONS
  The results of our study show that in hepatocellular carcinoma patients after liver transplantation, the lung and pleura are the most frequent site of recurrence, followed by liver, lymph node and bone as the second and third sites. The Stage IVb hepatocellular carcinoma should be regarded as a contradiction for liver transplantation due to rapid recurrence. Tumor recurrence occurs later in stage II HCC than in stage III approximately IVb patients. MSCT and MRI are of significant importance in diagnosis and formulating operation plan in HCC patients with recurrence after liver transplantation.
authors.affiliation: Department of Diagnostic Radiology, the Third Affiliated Hospital, Sun Yat-sen University, Guangzhou, China.
authors.forename: Jin
authors.initials: J
authors.lastname: Wang
authors.forename: Bing-jun
authors.initials: BJ
authors.lastname: He
authors.forename: Zai-bo
authors.initials: ZB
authors.lastname: Jiang
authors.forename: Ya-qin
authors.initials: YQ
authors.lastname: Zhang
authors.forename: Hong
authors.initials: H
authors.lastname: Shan
authors.forename: Ru
authors.initials: R
authors.lastname: Xiao
authors.forename: Jian-sheng
authors.initials: JS
authors.lastname: Zhang
authors.forename: Lin
authors.initials: L
authors.lastname: Luo
authors.forename: Si-chi
authors.initials: SC
authors.lastname: Kuang
authors.forename: Gui-hua
authors.initials: GH
authors.lastname: Chen
authors.forename: Yang
authors.initials: Y
authors.lastname: Yang
mesh_terms: D000328:Adult; D006528:Carcinoma, Hepatocellular / Q000175:diagnosis / Q000000981:diagnostic imaging / Q000556:secondary* / Q000601:surgery; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008113:Liver Neoplasms / Q000175:diagnosis* / Q000000981:diagnostic imaging / Q000473:pathology / Q000601:surgery; D016031:Liver Transplantation; D008175:Lung Neoplasms / Q000175:diagnosis / Q000000981:diagnostic imaging / Q000556:secondary*; D008207:Lymphatic Metastasis; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000175:diagnosis / Q000000981:diagnostic imaging; D009360:Neoplastic Cells, Circulating; D010997:Pleural Neoplasms / Q000175:diagnosis / Q000000981:diagnostic imaging / Q000556:secondary; D012189:Retrospective Studies; D036542:Tomography, Spiral Computed / Q000379:methods*