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Pretransplantation Evaluation of the Cirrhotic Liver with Explantation Correlation: Accuracy of CT Arterioportography and Digital Subtraction Hepatic Angiography in Revealing Hepatocellular Carcinoma

¹ Department of Radiology, Kurt Amplatz Center, Innsbruck University Hospital, Anichstr. 35, 6020 Innsbruck, Austria.
² Institute of Pathology, Feldkirch Academic Teaching Hospital, 6800 Feldkirch, Austria.
³ Department of Transplantation-Surgery, Innsbruck University Hospital, 6020 Innsbruck, Austria.
⁴ Department of Gastroenterology, Innsbruck University Hospital, 6020 Innsbruck, Austria.

View larger version (17K): [in a new window]   Fig. 1A. —Graphs show receiver operating characteristic (ROC) curves representing findings of CT arterioportography (dotted line) and digital subtraction angiography (solid line), separately and combined (dashed line) in all patients. Parametric ROC models were performed for detection of any hepatocellular carcinoma by reviewer 1 for CT arterioportography and digital subtraction angiography and team 1 for CT arterioportography and digital subtraction angiography combination. Area under ROC curve was 0.66 (95% confidence interval [CI], 0.55–0.78) for CT arterioportography; 0.78 (95% CI, 0.68–0.88) for digital subtraction angiography; and 0.82 (95% CI, 0.72–0.91) for CT arterioportography and digital subtraction angiography combination.

View larger version (16K): [in a new window]   Fig. 1B. —Graphs show receiver operating characteristic (ROC) curves representing findings of CT arterioportography (dotted line) and digital subtraction angiography (solid line), separately and combined (dashed line) in all patients. Parametric ROC models were performed for detection of any hepatocellular carcinoma by reviewer 2 for CT arterioportography and digital subtraction angiography and team 2 for CT arterioportography and digital subtraction angiography combination. Area under ROC curve was 0.70 (95% CI, 0.59–0.81) for CT arterioportography; 0.84 (95% CI, 0.75–0.93) for digital subtraction angiography; and 0.84 (95% CI, 0.76–0.93) for CT arterioportography and digital subtraction angiography combination.

View larger version (16K): [in a new window]   Fig. 2A. —Graphs show receiver operating characteristics (ROC) curves representing findings of CT arterioportography (dotted line) and digital subtraction angiography (solid line), separately and combined (dashed line), in all patients with hepatocellular carcinoma. Parametric ROC models were performed for detection of any hepatocellular carcinoma by reviewer 1 for CT arterioportography and digital subtraction angiography and team 1 for CT arterioportography and digital subtraction angiography combination. Area under ROC curve was 0.44 (95% confidence interval [CI], 0.30–0.59) for CT arterioportography; 0.67 (95% CI, 0.53–0.81) for digital subtraction angiography; and 0.68 (95% CI, 0.54–0.82) for CT arterioportography and digital subtraction angiography combination.

View larger version (15K): [in a new window]   Fig. 2B. —Graphs show receiver operating characteristics (ROC) curves representing findings of CT arterioportography (dotted line) and digital subtraction angiography (solid line), separately and combined (dashed line), in all patients with hepatocellular carcinoma. Parametric ROC models were performed for detection of any hepatocellular carcinoma by reviewer 2 for CT arterioportography and digital subtraction angiography and team 2 for CT arterioportography and digital subtraction angiography combination. Area under ROC curve was 0.50 (95% CI, 0.35–0.65) for CT arterioportography; 0.73 (95% CI, 0.59–0.87) for digital subtraction angiography; and 0.73 (95% CI, 0.59–0.87) for CT arterioportography and digital subtraction angiography combination.

View larger version (140K): [in a new window]   Fig. 3A. —61-year-old man with cirrhosis due to unknown cause. CT arterioportogram shows nodular perfusion defect (black arrow) in segment VI, which was interpreted as hepatocellular carcinoma. Image also shows severe ascites (small white arrow) and portosystemic shunt (large white arrow) combined with varices in abdominal wall (arrowhead) indicating advanced cirrhosis.

View larger version (168K): [in a new window]   Fig. 3B. —61-year-old man with cirrhosis due to unknown cause. Selective digital subtraction hepatic angiogram depicts lobulated moderately hypervascular lesion (arrow) in right liver lobe. Lesion was characterized as non—hepatocellular carcinoma with certainty by both reviewers. Combining A and B resulted in ruling out hepatocellular carcinoma.

View larger version (157K): [in a new window]   Fig. 3C. —61-year-old man with cirrhosis due to unknown cause. Corresponding transverse section from explanted liver confirms presence of lesion (arrowheads) in segment VI. Although uncommon in cirrhosis, cavernous hemangioma was revealed at pathologic examination (not shown) that ruled out presence of malignancy.

View larger version (150K): [in a new window]   Fig. 4A. —59-year-old woman with cirrhosis due to hepatitis C and true-positive findings of poorly differentiated 8-mm hepatocellular carcinoma on CT arterioportography and digital subtraction angiography. CT arterioportogram shows nodular perfusion defect (arrow) in segment VII.

View larger version (129K): [in a new window]   Fig. 4B. —59-year-old woman with cirrhosis due to hepatitis C and true-positive findings of poorly differentiated 8-mm hepatocellular carcinoma on CT arterioportography and digital subtraction angiography. Selective digital subtraction hepatic angiogram depicts nodular hypervascular lesion (arrow) with definite tumor stain. Combining A and B supported presence of hepatocellular carcinoma with certainty.

View larger version (131K): [in a new window]   Fig. 4C. —59-year-old woman with cirrhosis due to hepatitis C and true-positive findings of poorly differentiated 8-mm hepatocellular carcinoma on CT arterioportography and digital subtraction angiography. Corresponding transverse section from explanted liver confirms presence of 0.8-cm hepatocellular carcinoma (arrow) in segment VII.

View larger version (153K): [in a new window]   Fig. 5A. —52-year-old man with cirrhosis due to hepatitis C and true-positive findings of 1.5-cm well-differentiated hepatocellular carcinoma on CT arterioportography and digital subtraction angiography. CT arterioportogram shows nodular perfusion defect (arrow) in segment VI.

View larger version (151K): [in a new window]   Fig. 5B. —52-year-old man with cirrhosis due to hepatitis C and true-positive findings of 1.5-cm well-differentiated hepatocellular carcinoma on CT arterioportography and digital subtraction angiography. Selective digital subtraction hepatic angiogram shows nodular tumor stain (arrow). Combining A and B supported presence of hepatocellular carcinoma with certainty.

View larger version (111K): [in a new window]   Fig. 5C. —52-year-old man with cirrhosis due to hepatitis C and true-positive findings of 1.5-cm well-differentiated hepatocellular carcinoma on CT arterioportography and digital subtraction angiography. Corresponding transverse section from explanted liver confirms presence of hepatocellular carcinoma (arrow) in segment VI.

View larger version (140K): [in a new window]   Fig. 6A. —57-year-old man with cirrhosis due to hematochromatosis and false-positive findings on CT arterioportography and digital subtraction angiography. CT arterioportogram shows nodular perfusion defect (arrow) in segment V lateral to gallbladder. Lesion was interpreted as hepatocellular carcinoma.

View larger version (140K): [in a new window]   Fig. 6B. —57-year-old man with cirrhosis due to hematochromatosis and false-positive findings on CT arterioportography and digital subtraction angiography. Selective digital subtraction hepatic angiogram depicts nodular hypervascular lesion (arrow) in right liver lobe. Lesion was interpreted as hepatocellular carcinoma. Combining A and B supported presence of hepatocellular carcinoma with certainty.

View larger version (149K): [in a new window]   Fig. 6C. —57-year-old man with cirrhosis due to hematochromatosis and false-positive findings on CT arterioportography and digital subtraction angiography. Corresponding transverse section from explanted liver confirms presence of nodular lesion (arrowheads) lateral to gallbladder. Microscopic examination (not shown) revealed conglomerate of regenerative nodules and ruled out presence of malignancy.

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