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 (original) (raw)

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.

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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

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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
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  2. Settimo Caruso
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  3. Mariapina Milazzo
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  4. Giuseppe Mamone
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  5. Gianluca Marrone
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  6. Roberto Miraglia
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  7. Luigi Maruzzelli
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  8. Vincenzo Carollo
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  9. Marta Ida Minervini
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  10. Giovanni Vizzini
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  11. Salvatore Grutttadauria
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  12. Bruno Gridelli
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Correspondence toAngelo Luca.

Additional information

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

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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

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