title: Multidetector computed tomography triphasic evaluation of the liver before transplantation:  importance of equilibrium phase washout and morphology for characterizing hypervascular lesions.
abstract: OBJECTIVE
  We aim to identify the sensitivity and positive predictive value (PPV) of arterial phase imaging in detecting hepatocellular carcinoma (HCC) and determine the added value of portal venous and equilibrium phase imaging and lesion morphology characterization.
  
  
  METHODS
  We reviewed all patients who underwent liver transplantation at our institution that had a triphasic multidetector computed tomography examination within 6 months of transplantation. Forty-seven hypervascular lesions were identified in 24 patients. Imaging findings were correlated with explant pathologic correlation.
  
  
  RESULTS
  Hypervascularity in the arterial phase resulted in sensitivity of 87.5% and PPV of 29.8%. The presence of washout in the equilibrium phase increased the PPV to 92.9% with a slight decrease in sensitivity (81.3%). The negative predictive value of hypervascular lesions without washout in the equilibrium phase was 97.1%. There was significant correlation between larger lesions and HCC and between round lesions and HCC.
  
  
  CONCLUSIONS
  The presence of washout in the equilibrium phase is a better indicator of malignancy.
authors.affiliation: Department of Radiology, Stanford University School of Medicine, Stanford, CA 94305, USA.
authors.forename: Yueyi I
authors.initials: YI
authors.lastname: Liu
authors.forename: Aya
authors.initials: A
authors.lastname: Kamaya
authors.forename: R Brooke
authors.initials: RB
authors.lastname: Jeffrey
authors.forename: Lewis K
authors.initials: LK
authors.lastname: Shin
mesh_terms: D000328:Adult; D000368:Aged; D006528:Carcinoma, Hepatocellular / Q000000981:diagnostic imaging*; D003287:Contrast Media; D005260:Female; D006801:Humans; D007472:Iohexol; D008113:Liver Neoplasms / Q000000981:diagnostic imaging*; D016031:Liver Transplantation; D008297:Male; D008875:Middle Aged; D061330:Multidetector Computed Tomography / Q000379:methods*; D011237:Predictive Value of Tests; D011857:Radiographic Image Interpretation, Computer-Assisted; D012189:Retrospective Studies; D012680:Sensitivity and Specificity; D018709:Statistics, Nonparametric
chemical_list: D003287:Contrast Media; D007472:Iohexol