title: Review of imaging techniques in the diagnosis of hepatocellular carcinoma in patients who require a liver transplant.
abstract: OBJECTIVE
  The aim of the study was to retrospectively compare the diagnostic performance of ultrasound (US), contrast-enhanced multidetector computed tomography (MDCT) and contrast-enhanced MRI in cirrhotic patients who were candidates for liver transplantation.
  
  
  METHODS
  A total of 273 consecutive patients with 218 hepatocellular carcinoma (HCC) nodules, who underwent imaging and subsequent transplantation, were examined. Diagnosis of HCC was based on explant correlation of the whole liver. Three different imaging data sets were evaluated: US, MDCT and MRI unenhanced and dynamic phases. Diagnostic accuracy, sensitivity, specificity, positive predictive value and negative predictive value, with corresponding 95% confidence intervals, were determined. Statistical analysis was performed for all lesions and for two lesion subgroups (≤2 and >2 cm). Preoperative tumour staging was analysed.
  
  
  RESULTS
  Patient sensitivity to US, MDCT and MRI was 80.4, 81.1 and 90.5%, respectively. Specificity was 96.3, 96.2 and 82.1%. Combined US and MDCT improved sensitivity (88%) without significant loss in specificity (95.7%). Imaging tests resulted in accurate tumour staging in 83.4% of the patients. In per-nodule analysis, technique sensitivity was 55.6, 52.4 and 65.9%, respectively. Sensitivity figures improved when the nodule was larger than 2 cm.
  
  
  CONCLUSIONS
  Combining imaging techniques is a good strategy for pretransplant HCC diagnosis and provides more accurate cancer staging in patients, which is necessary to decide the correct therapeutic approach.
authors.affiliation: aDiagnostic Radiology Service bGeneral Surgery Department cHepatology and Digestive Apparatus Department dAnatomic Pathology Department, Hospital Universitario Río Hortega eDepartment of Medicine, Dermatology and Toxicology, Faculty of Medicine, University of Valladolid, Valladolid, Spain.
authors.forename: Elena
authors.initials: E
authors.lastname: Villacastín Ruiz
authors.forename: Agustín
authors.initials: A
authors.lastname: Caro-Patón Gómez
authors.forename: Hermógenes
authors.initials: H
authors.lastname: Calero Aguilar
authors.forename: Baltasar
authors.initials: B
authors.lastname: Pérez Saborido
authors.forename: Félix
authors.initials: F
authors.lastname: García Pajares
authors.forename: Gloria
authors.initials: G
authors.lastname: Sánchez Antolín
authors.forename: Beatriz
authors.initials: B
authors.lastname: Madrigal Rubiales
authors.forename: David
authors.initials: D
authors.lastname: Pacheco Sánchez
authors.forename: Rebeca
authors.initials: R
authors.lastname: Pintado Garrido
authors.forename: Sara
authors.initials: S
authors.lastname: Plaza Loma
authors.forename: Trinidad
authors.initials: T
authors.lastname: Escudero Caro
mesh_terms: D000328:Adult; D000368:Aged; D006528:Carcinoma, Hepatocellular / Q000000981:diagnostic imaging* / Q000401:mortality / Q000473:pathology / Q000601:surgery; D003287:Contrast Media; D005260:Female; D006801:Humans; D008113:Liver Neoplasms / Q000000981:diagnostic imaging* / Q000401:mortality / Q000473:pathology / Q000601:surgery; D016031:Liver Transplantation; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D061330:Multidetector Computed Tomography; D009367:Neoplasm Staging; D011237:Predictive Value of Tests; D015203:Reproducibility of Results; D012189:Retrospective Studies; D014463:Ultrasonography
chemical_list: D003287:Contrast Media