title: Effect of MRI Versus MDCT on Milan Criteria Scores and Liver Transplantation Eligibility.
abstract: OBJECTIVE
  The Milan criteria for the selection of patients with hepatocellular carcinoma (HCC) for liver transplantation were originally based on the findings of contrast-enhanced CT examinations. Studies have shown improvement in HCC detection of using contrast-enhanced MRI instead of CT, but they have provided little information on the potential downstream effect on patient management that might result from discrepant imaging findings. We sought to assess the effect of discrepant imaging findings on patient eligibility to undergo liver transplantation.
  
  
  METHODS
  From 2006 to 2013, patients with a diagnosis of HCC who underwent both MDCT and MRI examinations within a 40-day period were studied retrospectively. All examinations were independently reviewed by two abdominal radiologists who recorded the number, diameter, and location of each lesion. Secondary confirmation of the lesions was made on the basis of histopathologic findings, diffusion restriction on DWI, increased T2 signal intensity, lesion growth, presence of fat, uptake of ethiodized oil, or a combination of these findings.
  
  
  RESULTS
  Sixty-four patients (48 men and 16 women; mean age, 62 years) met the criteria for inclusion in the study. Of the 129 lesions identified by MRI, only 102 of these lesions (79%) were identified by MDCT. This discrepancy led to a difference in the Milan criteria scoring for nine patients (14%). There was no statistically significant difference in the mean (± SD) greatest lesion diameter measured using the two modalities, with measurements of 3.52 ± 2.8 cm and 3.46 ± 2.8 cm noted on MDCT and MRI, respectively (p = 0.8). Lesions missed on MDCT studies tended to be smaller, with a mean diameter of 2.7 cm. Of the 129 lesions identified by MRI, 112 (87%) had available histopathologic findings or other confirmatory diagnostic evidence.
  
  
  CONCLUSIONS
  MDCT missed one-fifth of the HCC lesions detected by MRI. Had MDCT been the only imaging examination performed, failure to identify these lesions would have led to a different management plan for 14% of patients.
authors.affiliation: 1 Department of Radiology, University of Minnesota, 420 Delaware St SE, Mayo Memorial Bldg, Minneapolis, MN 55455.
authors.forename: Nassir
authors.initials: N
authors.lastname: Rostambeigi
authors.affiliation: 1 Department of Radiology, University of Minnesota, 420 Delaware St SE, Mayo Memorial Bldg, Minneapolis, MN 55455.
authors.forename: Andrew J
authors.initials: AJ
authors.lastname: Taylor
authors.affiliation: 1 Department of Radiology, University of Minnesota, 420 Delaware St SE, Mayo Memorial Bldg, Minneapolis, MN 55455.
authors.forename: Jafar
authors.initials: J
authors.lastname: Golzarian
authors.affiliation: 2 Department of Surgery, University of Minnesota, Minneapolis, MN.
authors.forename: Eric H
authors.initials: EH
authors.lastname: Jensen
authors.affiliation: 2 Department of Surgery, University of Minnesota, Minneapolis, MN.
authors.forename: Timothy L
authors.initials: TL
authors.lastname: Pruett
authors.affiliation: 2 Department of Surgery, University of Minnesota, Minneapolis, MN.
authors.forename: Vikas
authors.initials: V
authors.lastname: Dudeja
authors.affiliation: 1 Department of Radiology, University of Minnesota, 420 Delaware St SE, Mayo Memorial Bldg, Minneapolis, MN 55455.
authors.forename: Donna
authors.initials: D
authors.lastname: D'Souza
mesh_terms: D000465:Algorithms; D006528:Carcinoma, Hepatocellular / Q000473:pathology*; D003287:Contrast Media; D005260:Female; D019786:Gadolinium DTPA; D006801:Humans; D007090:Image Interpretation, Computer-Assisted; D007479:Iopamidol; D008113:Liver Neoplasms / Q000473:pathology*; D016031:Liver Transplantation; D008279:Magnetic Resonance Imaging / Q000379:methods*; D008297:Male; D008875:Middle Aged; D009942:Organometallic Compounds; D018579:Patient Selection; D012189:Retrospective Studies; D014057:Tomography, X-Ray Computed / Q000379:methods*
chemical_list: D003287:Contrast Media; D009942:Organometallic Compounds; C073590:gadolinium ethoxybenzyl DTPA; C090600:gadobutrol; D007479:Iopamidol; D019786:Gadolinium DTPA
keywords: MRI; Milan criteria; hepatocellular carcinoma; liver transplantation