Skip to main content
SpringerLink
Log in

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

  • Oncology
  • Published:
European Radiology Aims and scope Submit manuscript

An Erratum to this article was published on 18 February 2011

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.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3

Similar content being viewed by others

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

References

  1. Stigliano R, Burroughs AK (2005) Should we biopsy each liver mass suspicious for HCC before liver transplantation? No, please don’t. J Hepatol 43:563–568

    Article  CAS  PubMed  Google Scholar 

  2. Kojiro M, Nakashima O (1999) Histopathologic evaluation of hepatocellular carcinoma with special reference to small early stage tumors. Semin Liver Dis 19:287–296

    Article  CAS  PubMed  Google Scholar 

  3. Kojiro M (2004) Focus on dysplastic nodules and early hepatocellular carcinoma: an Eastern point of view. Liver Transpl 10(Suppl 1):S3–S8

    Article  PubMed  Google Scholar 

  4. Forner A, Vilana R, Ayuso C et al (2008) Diagnosis of hepatic nodules 20 mm or smaller in cirrhosis; prospective validation of the noninvasive diagnostic criteria for hepatocellular carcinoma. Hepatology 47:97–104

    Article  PubMed  Google Scholar 

  5. Bruix J, Sherman M (2005) Management of hepatocellular carcinoma. Hepatology 42:1208–1236

    Article  PubMed  Google Scholar 

  6. Lopez Hanninen E, Vogl TJ, Bechstein WO et al (1998) Biphasic spiral computed tomography for detection of hepatocellular carcinoma before resection or orthotopic liver transplantation. Invest Radiol 4:216–221

    Article  Google Scholar 

  7. Peterson MS, Baron RL, Marsh JW et al (2000) Pretransplantation surveillance for possible hepatocellular carcinoma in patients with cirrhosis: epidemiology and CT-based tumor detection rate in 430 cases with surgical pathologic correlation. Radiology 217:743–749

    CAS  PubMed  Google Scholar 

  8. Lim JH, Kim CK, Lee WJ et al (2000) Detection of hepatocellular carcinomas and dysplastic nodules in cirrhotic livers: accuracy of helical CT in transplant patients. AJR Am J Roentgenol 175:693–698

    CAS  PubMed  Google Scholar 

  9. Mortele KJ, De Keukeleire K, Praet M et al (2001) Malignant focal hepatic lesions complicating underlying liver disease: dual-phase contrast-enhanced spiral CT sensitivity and specificity in orthotopic liver transplant patients. Eur Radiol 11:1631–1638

    Article  CAS  PubMed  Google Scholar 

  10. Rode A, Bancel B, Douek P et al (2001) Small nodule detection in cirrhotic livers: evaluation with US, spiral CT, and MRI and correlation with pathologic examination of explanted liver. J Comput Assist Tomogr 25:327–336

    Article  CAS  PubMed  Google Scholar 

  11. de Lèdinghen V, David Laharie D, Lecesne R et al (2002) Detection of nodules in liver cirrhosis: spiral computed tomography or magnetic resonance imaging? A prospective study of 88 nodules in 34 patients. Eur J Gastroenterol Hepatol 14:159–165

    Article  PubMed  Google Scholar 

  12. Zacherl J, Pokieser P, Wrba F et al (2002) Accuracy of multiphasic helical computed tomography and intraoperative sonography in patients undergoing orthotopic liver transplantation for hepatoma: What is the truth? Ann Surg 4:528–532

    Article  Google Scholar 

  13. Freeny PC, Grossholz M, Kaakaji K et al (2003) Significance of hyperattenuating and contrast-enhancing hepatic nodules detected in the cirrhotic liver during arterial phase helical CT in pre-liver transplant patients: radiologic–histopathologic correlation of explanted livers. Abdom Imaging 28:333–346

    Article  CAS  PubMed  Google Scholar 

  14. Burrel M, Llovet JM, Ayuso C et al (2003) MRI angiography is superior to helical CT for detection of HCC prior to liver transplantation: an explant correlation. Hepatology 38:1034–1042

    PubMed  Google Scholar 

  15. Teefey SA, Hildeboldt CC, Dehdashti F et al (2003) Detection of primary hepatic malignancy in liver transplant candidates: prospective comparison of CT, MR imaging, US, and PET. Radiology 226:533–542

    Article  PubMed  Google Scholar 

  16. Valls C, Cos M, Figueras J et al (2004) Pretransplantation diagnosis and staging of hepatocellular carcinoma in patients with cirrhosis: value of dual-phase helical CT. AJR Am J Roentgenol 182:1011–1017

    PubMed  Google Scholar 

  17. Ronzoni A, Artioli D, Scardina R (2007) Role of MDCT in the diagnosis of hepatocellular carcinoma in patients with cirrhosis undergoing orthotopic liver transplantation. AJR Am J Roentgenol 189:792–798

    Article  PubMed  Google Scholar 

  18. Freeman RB, Mithoefer A, Ruthazer R et al (2006) Optimizing staging for hepatocellular carcinoma before liver transplantation: a retrospective analysis of the UNOS/OPTN database. Liver Transpl 12:1504–1511

    Article  PubMed  Google Scholar 

  19. Lim JH, Choi D, Kim SH et al (2002) Detection of hepatocellular carcinoma: value of adding delayed phase imaging to dual-phase helical CT. AJR Am J Roentenol 179:67–73

    Google Scholar 

  20. Iannaccone R, Laghi A, Catalano C et al (2005) Hepatocellular carcinoma: role of unenhanced and delayed phase multi-detector row helical CT in patients with cirrhosis. Radiology 234:460–467

    Article  PubMed  Google Scholar 

  21. Monzawa S, Ichikawa T, Nakajima H et al (2007) Dynamic CT for detecting small hepatocellular carcinoma: usefulness of delayed phase imaging. AJR Am J Roentgenol 188:147–152

    Article  PubMed  Google Scholar 

  22. Yanaga Y, Awai K, Nakaura T et al (2008) Optimal Contrast dose for depiction of hypervascular hepatocellular carcinoma at dynamic CT using 64-MDCT. AJR Am J Roentgenol 190:1003–1009

    Article  PubMed  Google Scholar 

  23. International Working Party (1995) Terminology of nodular hepatocellular lesions: International Working Party. Hepatology 22:983–993

    Google Scholar 

  24. Edmondson HA, Steiner PE (1954) Primary carcinoma of the liver. A study of 100 cases among 48900 necropsies. Cancer 7:462–503

    Article  CAS  PubMed  Google Scholar 

  25. Tatsioni A, Zarin DA, Aronson N et al (2005) Challenges in systematic reviews of diagnostic technologies. Ann Intern Med 142:1048–1055

    PubMed  Google Scholar 

  26. Liver Transplant candidates with hepatocellular carcinoma. United Network for Organ Sharing (UNOS) Policies 3.6.4.4. Available at: http://unos.org/PoliciesandBylaws2/policies/pdfs/policy_8.pdf Accessed 12 July 2009

  27. Jeong YY, Mitchell DG, Kamishima T (2002) Small (≤20 mm) enhancing hepatic nodules seen on arterial phase MR imaging of the cirrhotic liver: clinical implications. AJR Am J Roentgenol 178:1327–1334

    PubMed  Google Scholar 

  28. Shimizu A, Ito K, Koike S et al (2003) Cirrhosis or chronic hepatitis: evaluation of small (≤2-cm) early-enhancing hepatic lesions with serial contrast-enhanced dynamic MR imaging. Radiology 226:550–555

    Article  PubMed  Google Scholar 

  29. O’Malley ME, Takayama Y, Sherman M (2005) Outcome of small (10–20 mm) arterial phase-enhancing nodules seen on triphasic liver CT in patients with cirrhosis or chronic liver disease. Am J Gastroenterol 100:1523–1528

    Article  PubMed  Google Scholar 

  30. Freeny PC, Grossholz M, Kaakaji K et al (2003) Significance of hyperattenuating and contrast-enhancing hepatic nodules detected in the cirrhotic liver during arterial phase helical CT in pre-liver transplant patients: radiologic-histopathologic correlation of explanted livers. Abdom Imaging 8:333–346

    Article  Google Scholar 

  31. Holland AE, Hecht EM, Hahn WY et al (2005) Importance of small (≤20-mm) enhancing lesions seen only during the hepatic arterial phase at MR imaging of the cirrhotic liver: evaluation and comparison with whole explanted liver. Radiology 237:938–944

    Article  PubMed  Google Scholar 

  32. Bolondi L, Gaiani S, Celli N et al (2005) Characterization of small nodules in cirrhosis by assessment of vascularity: the problem of hypovascular hepatocellular carcinoma. Hepatology 42:27–34

    Article  PubMed  Google Scholar 

  33. Doyle DJ, O’Malley ME, Jang HJ et al (2007) Value of the unenhanced phase for detection of hepatocellular carcinomas 3 cm or less when performing multiphase computed tomography in patients with cirrhosis. J Comput Assist Tomogr 31:86–92

    Article  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Radiology, Mediterranean Institute for Transplantation and Advanced Specialized Therapies (ISMETT), Palermo, Italy

    Angelo Luca, Settimo Caruso, Mariapina Milazzo, Giuseppe Mamone, Gianluca Marrone, Roberto Miraglia, Luigi Maruzzelli & Vincenzo Carollo

  2. Department of Pathology, Mediterranean Institute for Transplantation and Advanced Specialized Therapies (ISMETT), Palermo, Italy

    Marta Ida Minervini

  3. Department of Medicine, Mediterranean Institute for Transplantation and Advanced Specialized Therapies (ISMETT), Palermo, Italy

    Giovanni Vizzini

  4. Department of Surgery, Mediterranean Institute for Transplantation and Advanced Specialized Therapies (ISMET), Palermo, Italy

    Salvatore Grutttadauria & Bruno Gridelli

  5. University of Pittsburgh Medical Center (UPMC), Pittsburgh, PA, USA

    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

Authors
  1. Angelo Luca
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Settimo Caruso
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Mariapina Milazzo
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Giuseppe Mamone
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Gianluca Marrone
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Roberto Miraglia
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Luigi Maruzzelli
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Vincenzo Carollo
    View author publications

    You can also search for this author in PubMed Google Scholar

  9. Marta Ida Minervini
    View author publications

    You can also search for this author in PubMed Google Scholar

  10. Giovanni Vizzini
    View author publications

    You can also search for this author in PubMed Google Scholar

  11. Salvatore Grutttadauria
    View author publications

    You can also search for this author in PubMed Google Scholar

  12. Bruno Gridelli
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Angelo Luca.

Additional information

An erratum to this article can be found at http://dx.doi.org/10.1007/s00330-011-2070-1

Rights and permissions

Reprints and permissions

About this article

Cite this article

Luca, A., Caruso, S., Milazzo, M. et al. 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. Eur Radiol 20, 898–907 (2010). https://doi.org/10.1007/s00330-009-1622-0

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00330-009-1622-0

Keywords

Search

Navigation