European Radiology

, Volume 20, Issue 4, pp 898–907

Multidetector-row computed tomography (MDCT) for the diagnosis of hepatocellular carcinoma in cirrhotic candidates for liver transplantation: prevalence of radiological vascular patterns and histological correlation with liver explants

  • Angelo Luca
  • Settimo Caruso
  • Mariapina Milazzo
  • Giuseppe Mamone
  • Gianluca Marrone
  • Roberto Miraglia
  • Luigi Maruzzelli
  • Vincenzo Carollo
  • Marta Ida Minervini
  • Giovanni Vizzini
  • Salvatore Grutttadauria
  • Bruno Gridelli
Oncology

Abstract

Aim

To define the prevalence of different multidetector-row computed tomography (MDCT) vascular patterns and their histopathological correlation with liver explants, and to evaluate the accuracy of MDCT for the diagnosis of hepatocellular carcinoma (HCC).

Methods

We retrospectively reviewed 125 cirrhotic patients imaged by MDCT before liver transplantation. Three main vascular patterns were identified: hypervascular lesion with washout (Hyper-L-Wo), hypervascular lesion without washout (Hyper-L) and non-hypervascular lesion (Hypo-L). Radiological findings were matched with histopathology of explants.

Results

Positive predictive value (PPV) and likelihood ratio (LR) were 95% and 18.66, respectively, for Hyper-L-Wo; 45% and 0.82 for Hyper-L; and 75% and 3 for Hypo-L of 20 mm or larger. Overall accuracy of MDCT for detection and characterisation of HCC was 89% and 43%, respectively. Sensitivity of MDCT for detection and characterisation was related to the lesion size, ranging from 78% (lesion smaller than 10 mm) to 98% (larger than 20 mm) and from 9% to 64%, respectively. MDCT established the accurate stage of disease in 46% of the patients, underestimated in 52% and overestimated in 2%.

Conclusion

In cirrhotic patients, any Hyper-L-Wo detected by MDCT can be confidently considered to be HCC. Hyper-L larger than 10 mm and Hypo-L of 20 mm or larger are at high risk of HCC. However, even using MDCT and the newest imaging protocols, imaging underestimated the diagnosis of small HCC.

Keywords

Cirrhosis Liver transplantation Hepatocellular carcinoma Computed tomography Diagnosis 

Abbreviations

MDCT

multidetector-row helical CT

HCC

hepatocellular carcinoma

MRN

macroregenerative nodule

HGDN

high-grade dysplastic nodule

PPV

positive predictive value

NPV

negative predictive value

LR

likelihood ratio

MELD

model for end-stage liver disease

UNOS

United Network of Organ Sharing

Copyright information

© European Society of Radiology 2009

Authors and Affiliations

  • Angelo Luca
    • 1
    • 5
  • Settimo Caruso
    • 1
    • 5
  • Mariapina Milazzo
    • 1
    • 5
  • Giuseppe Mamone
    • 1
    • 5
  • Gianluca Marrone
    • 1
    • 5
  • Roberto Miraglia
    • 1
    • 5
  • Luigi Maruzzelli
    • 1
    • 5
  • Vincenzo Carollo
    • 1
    • 5
  • Marta Ida Minervini
    • 2
    • 5
  • Giovanni Vizzini
    • 3
    • 5
  • Salvatore Grutttadauria
    • 4
    • 5
  • Bruno Gridelli
    • 4
    • 5
  1. 1.Department of RadiologyMediterranean Institute for Transplantation and Advanced Specialized Therapies (ISMETT)PalermoItaly
  2. 2.Department of PathologyMediterranean Institute for Transplantation and Advanced Specialized Therapies (ISMETT)PalermoItaly
  3. 3.Department of MedicineMediterranean Institute for Transplantation and Advanced Specialized Therapies (ISMETT)PalermoItaly
  4. 4.Department of SurgeryMediterranean Institute for Transplantation and Advanced Specialized Therapies (ISMET)PalermoItaly
  5. 5.University of Pittsburgh Medical Center (UPMC)PittsburghUSA

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