title: Prognostic significance of preoperative imaging in recipients of living donor liver transplantation for hepatocellular carcinoma.
abstract: BACKGROUND
  Accurate preoperative imaging is an important aspect of patient evaluation before liver transplantation for hepatocellular carcinoma (HCC) because the size and number of tumors are indicators of posttransplant prognosis. This study aimed to evaluate the preoperative detectability of HCC and clarify the role of preoperative assessment on prognosis after living donor liver transplantation (LDLT).
  
  
  METHODS
  Eighty-one patients who underwent LDLT for HCC accompanied by liver cirrhosis were reviewed. A total of 149 nodules were pathologically diagnosed as HCCs. The pathologic findings were correlated with preoperative results from contrast-enhanced computed tomography, magnetic resonance imaging, and computed tomography with angiography.
  
  
  RESULTS
  The detectability of small HCCs (<1 cm) and well-differentiated HCCs was significantly reduced. Forty-six of 81 cases were preoperatively judged to meet the Milan criteria, although 16 of these failed to meet the criteria according to postoperative pathologic examination. However, recurrence-free survival in the 16 cases was similar to that in the 30 cases who met the criteria.
  
  
  CONCLUSIONS
  The preoperative diagnostic accuracy of radiologic imaging for small-sized, well-differentiated HCCs requires improvement. However, these undetected HCCs have little effect on prognosis after LDLT, and current imaging modalities therefore provide acceptable methods of preoperative LDLT evaluation.
authors.affiliation: Department of Surgery and Science, Graduate School of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Higashi-ku, Fukuoka, Japan. ksugi@surg2.med.kyushu-u.ac.jp
authors.forename: Keishi
authors.initials: K
authors.lastname: Sugimachi
authors.forename: Ken
authors.initials: K
authors.lastname: Shirabe
authors.forename: Akinobu
authors.initials: A
authors.lastname: Taketomi
authors.forename: Yuji
authors.initials: Y
authors.lastname: Soejima
authors.forename: Tomohiro
authors.initials: T
authors.lastname: Iguchi
authors.forename: Kazuki
authors.initials: K
authors.lastname: Takeishi
authors.forename: Takeo
authors.initials: T
authors.lastname: Toshima
authors.forename: Shinichi
authors.initials: S
authors.lastname: Aishima
authors.forename: Tsuyoshi
authors.initials: T
authors.lastname: Tajima
authors.forename: Yoshihiko
authors.initials: Y
authors.lastname: Maehara
mesh_terms: D000328:Adult; D000368:Aged; D000792:Angiography; D006528:Carcinoma, Hepatocellular / Q000175:diagnosis* / Q000401:mortality / Q000601:surgery*; D005500:Follow-Up Studies; D006801:Humans; D008113:Liver Neoplasms / Q000175:diagnosis* / Q000401:mortality / Q000601:surgery*; D016031:Liver Transplantation; D019520:Living Donors; D008279:Magnetic Resonance Imaging; D008875:Middle Aged; D011379:Prognosis; D012189:Retrospective Studies; D015996:Survival Rate; D014057:Tomography, X-Ray Computed