title: Cardiophrenic lymph nodes in liver transplant candidates with hepatocellular carcinoma: imaging characteristics and post-transplant outcomes.
abstract: BACKGROUND
  No guidelines exist for the management of cardiophrenic lymph nodes in patients with hepatocellular carcinoma (HCC) being evaluated for liver transplantation.
  
  
  METHODS
  One hundred and seventy-eight patients with HCC listed for liver transplant received both pre-transplant computed tomography (CT) and follow-up CT scans. Enlarged cardiophrenic lymph nodes on CT were characterized and followed on subsequent scans; lymph node outcomes were assigned to "reduced" and "not reduced" categories. Tumor and patient characteristics were also recorded.
  
  
  RESULTS
  Seventy-one of one hundred and seventy-eight patients (39.9%) had at least one cardiophrenic lymph node larger than 8 mm in diameter on pre-transplant CT. One hundred and sixty-six total lymph nodes were characterized. Six lymph nodes (3.6%) in two patients increased in size on follow-up imaging; all six cardiophrenic lymph nodes were presumed to represent metastases. There was a statistically significant reduction in lymph node size in patients who were transplanted vs. those who were not transplanted. Furthermore, a statistically significant association was found between increasing Model for End-Stage Liver Disease score and lymph node size reduction. There were no significant differences in post-transplant survival between patients with different lymph node outcomes.
  
  
  CONCLUSIONS
  In the absence of metastatic disease in other sites, these lymph nodes are probably reactive; further workup is likely not necessary.
authors.affiliation: Department of Radiology, Keck School of Medicine of USC, Los Angeles, CA, USA.
authors.forename: Christopher
authors.initials: C
authors.lastname: Lee
authors.forename: Andrew
authors.initials: A
authors.lastname: Kim
authors.forename: Idoia
authors.initials: I
authors.lastname: Santos
authors.forename: Yong
authors.initials: Y
authors.lastname: Cen
authors.forename: Sophoclis
authors.initials: S
authors.lastname: Alexopoulos
authors.forename: Shannon
authors.initials: S
authors.lastname: Navarro
authors.forename: Melissa
authors.initials: M
authors.lastname: Wallman
authors.forename: Kiran
authors.initials: K
authors.lastname: Dhanireddy
authors.forename: Edward
authors.initials: E
authors.lastname: Grant
mesh_terms: D006528:Carcinoma, Hepatocellular / Q000401:mortality / Q000473:pathology / Q000601:surgery*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007091:Image Processing, Computer-Assisted; D008113:Liver Neoplasms / Q000401:mortality / Q000473:pathology / Q000601:surgery*; D016031:Liver Transplantation; D008198:Lymph Nodes / Q000000981:diagnostic imaging / Q000473:pathology*; D008297:Male; D008875:Middle Aged; D010496:Pericardium / Q000000981:diagnostic imaging / Q000473:pathology*; D011184:Postoperative Period; D011379:Prognosis; D012189:Retrospective Studies; D012307:Risk Factors; D015996:Survival Rate; D014057:Tomography, X-Ray Computed
keywords: hepatocellular carcinoma; liver transplantation; lymph nodes; metastasis; multidetector computed tomography