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Role of MDCT in the Diagnosis of Hepatocellular Carcinoma in Patients with Cirrhosis Undergoing Orthotopic Liver Transplantation

¹ School of Medicine, University of Milano-Bicocca, Milan, Italy.
² Department of Diagnostic Radiology, A. O. Niguarda Ca Granda, Piazza Ospedale Maggiore, Milan 20162, Italy.
³ Department of Diagnostic Radiology, A. O. Vimercate, Milan, Italy.
⁴ Department of Diagnostic Radiology, Policlinico di Monza, Milan, Italy.
⁵ Department of Pathology, A. O. Niguarda Ca Granda, Milan, Italy.
⁶ Department of Diagnostic Radiology, A. O. S. Gerardo Monza, Milan, Italy.

OBJECTIVE. The purpose of this study was to assess the diagnostic performance of MDCT in the detection of hepatocellular carcinoma in patients with cirrhosis undergoing orthotopic liver transplantation.

MATERIALS AND METHODS. Eighty-eight consecutively registered patients who underwent MDCT 6 months before liver transplantation were evaluated. The original reports were analyzed, and the CT images were retrospectively reevaluated independently by two radiologists who made the final interpretation in consensus. The imaging findings were correlated with histopathologic findings in the explanted livers on a patient-by-patient and a lesion-by-lesion basis.

RESULTS. Histopathologic examination revealed 139 hepatocellular carcinomas in 48 of the 88 patients. MDCT correctly depicted 89 of 139 hepatocellular carcinomas (sensitivity, 64%) at the original examination and 102 at reevaluation (sensitivity, 73.3%). Patient-by-patient analysis showed a specificity of 75% in the original reports and of 77.5% at reevaluation. A large number of false-positive nodules were found, most (59.2%) of them being smaller than 1 cm in diameter.

CONCLUSION. MDCT has reasonable sensitivity in the detection of hepatocellular carcinoma in patients with cirrhosis who undergo liver transplantation. Attention should be paid, however, to avoiding overestimation of the extent of disease.

Keywords: explanted liver • hepatocellular carcinoma • MDCT

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