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Imaging prediction of residual hepatocellular carcinoma after locoregional therapy in patients undergoing liver transplantation or partial hepatectomy

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Abstract

Purpose

Locoregional therapies for hepatocellular carcinoma (HCC) offer alternatives for patients unable to undergo resection or awaiting transplant. We sought to evaluate the prevalence and interobserver agreement of imaging features suggestive of viable tumor at posttherapy CT/MRI and to determine a size threshold for tumor detection.

Methods

Patients having undergone liver transplant or hepatectomy between 2012 and 2014 with presurgical embolization or ablation of HCC were identified. Imaging was retrospectively reviewed, and enhancement characteristics of each lesion were noted by two radiologists. Original pathology slides were reviewed, and the size of nodular viable tumor was noted, if present. Cohen’s kappa was used to evaluate interobserver agreement.

Results

87 patients with 129 HCCs were reviewed retrospectively following IRB approval. 50% (65/129) of lesions showed viable tumor at pathology. 86 lesions (67%) were imaged with CT and 43 (33%) with MR. Of viable lesions, 25 (38%) showed nodular arterial enhancement and 18 (28%) demonstrated washout. One lesion had capsule appearance. Sensitivity/specificity for nodular enhancement, washout, and capsule were 0.38/0.83, 0.28/0.89, and 0.02/1.00, respectively. Overall detection rate was 41% of <1 cm, 54% of 1–2 cm, and 57% of >2 cm viable lesions.

Conclusions

Nodular arterial enhancement was most frequently observed, followed by washout. Both showed moderate interobserver agreement. Sensitivity of any imaging feature was less than 50%, though findings were specific for viable disease. There is limited detection of nodules of viable tumor <1 cm and only marginal detection of larger lesions, though MRI outperformed CT for the detection of subcentimeter viable tumor

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Author information

Authors and Affiliations

  1. Department of Radiology and Biomedical Imaging, UCSF, 505 Parnassus Ave., San Francisco, CA, 94143-0628, USA

    Eric C. Ehman & Nicholas Fidelman

  2. Department of Pathology, UCSF, 505 Parnassus Ave., Room 580, San Francisco, CA, 94143, USA

    Sarah E. Umetsu

  3. Department of Radiology, ZSFG, 1001 Potrero Ave, ZSFG Bldg 5, San Francisco, CA, 94110, USA

    Michael A. Ohliger

  4. Department of Pathology, UCSF, 505 Parnassus Ave., Moffitt Rm 590A, San Francisco, CA, 94143, USA

    Linda D. Ferrell

  5. Department of Radiology and Biomedical Imaging, UCSF, 513 Parnassus Ave., Med Sci M372, San Francisco, CA, 94143, USA

    Ben M. Yeh

  6. Department of Radiology, VAMC San Francisco, 3333 California St, San Francisco, CA, 94118, USA

    Judy Yee

  7. Department of Radiology, VAMC San Francisco, 4150 Clement St., Room 2D007, San Francisco, CA, 94121, USA

    Thomas A. Hope

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  1. Eric C. Ehman
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Corresponding author

Correspondence to Eric C. Ehman.

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Funding

No grant funding was used in this study.

Conflict of interest

Eric Ehman declares that he has no conflict of interest. Sarah Umetsu declares that she has no conflict of interest. Michael Ohliger declares that he has no conflict of interest. Nicholas Fidelman declares that he has no conflict of interest. Linda Ferrell declares that she has no conflict of interest. Ben Yeh declares that he has no conflict of interest. Judy Yee declares that she has no conflict of interest. Thomas Hope declares that he has no conflict of interest.

Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

Informed consent

The need for individual informed consent was waived by our institutional review board (IRB) for this retrospective study.

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Ehman, E.C., Umetsu, S.E., Ohliger, M.A. et al. Imaging prediction of residual hepatocellular carcinoma after locoregional therapy in patients undergoing liver transplantation or partial hepatectomy. Abdom Radiol 41, 2161–2168 (2016). https://doi.org/10.1007/s00261-016-0837-1

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  • DOI: https://doi.org/10.1007/s00261-016-0837-1

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