Transplantation for hepatocellular carcinoma and cirrhosis: ... : Liver Transplantation (original) (raw)

Articles: PDF Only

Transplantation for hepatocellular carcinoma and cirrhosis: Sensitivity of magnetic resonance imaging

Krinsky, Glenn A. MD*,1,4; Lee, Vivian S.1; Theise, Neil D.2; Weinreb, Jeffrey C.1; Morgan, Glyn R.3; Diflo, Thomas3; John, Devon3; Teperman, Lewis W.3

1Department of Radiology, New York University Medical Center, New York, NY

2Department of Pathology, New York University Medical Center, New York, NY

3Department of Transplant Surgery, New York University Medical Center, New York, NY

4Kaplan Comprehensive Cancer Center, New York University Medical Center, New York, NY

E-mail:[email protected]

*Address reprint requests to Department of Radiology, NYU Medical Center, Dept of MRI, 530 First Ave, New York, NY 10016. Telephone: 212-263-8290; FAX: 212-263-8186

Abstract

The sensitivity of magnetic resonance imaging (MRI) in patients who undergo transplantation for hepatocellular carcinoma (HCC) and cirrhosis is not known. We prospectively evaluated 24 patients with known HCC who underwent MRI and subsequent transplantation within 60 days (mean, 20 days). Using a phased-array coil at 1.5T, breath-hold turbo STIR and T2-weighted MR images were performed. Dynamic gadolinium-enhanced MRI was performed using a two- or three-dimensional gradient echo pulse sequence with images obtained in the hepatic arterial, portal venous, and equilibrium phases. The prospective interpretation of the MR study was directly compared with thin-section pathology evaluation of the explanted livers. All 24 patients had at least one HCC, and MR diagnosed tumor in 21 (88%) of these patients. On a lesion-by-lesion basis, MRI depicted 39 of 118 HCC for an overall sensitivity of 33%. MRI detected five (100%) of five lesions >5 cm, 20 (100%) of 20 lesions >2 cm but not exceeding 5 cm, 11 (52%) of 21 lesions between 1 and 2 cm, and three (4%) of 72 lesions <1 cm. Of the nine patients with carcinomatosis (innumerable lesions less than 1 cm), MR detected three lesions in one patient. Of the 15 dysplastic nodules found at pathology, MRI depicted a single 1.8-cm high-grade lesion, for a sensitivity of 7%. In conclusion, MRI is sensitive for the detection of HCC measuring at least 2 cm in diameter but is insensitive for the diagnosis of small HCC (<2 cm) and carcinomatosis.