DETECTION OF HEPATOCELLULAR-CARCINOMA IN CIRRHOTIC-PATIENTS - SENSITIVITY OF CT AND ULTRASONOGRAPHY

Patients with cirrhosis are at increased risk for the development of h epatocellular carcinoma. The heterogeneous hepatic parenchyma produced by cirrhosis makes detection of hepatomas more difficult. The purpose of this study was to determine the sensitivities of CT and ultrasonog raphy for detecting hepatomas in cirrhotic patients. A retrospective a nalysis was performed of 733 patients who underwent liver transplantat ion at our institution. A study population of 21 patients was selected who met our inclusion criteria. The inclusion criteria required a pat hologic diagnosis of hepatocellular carcinoma, pathologic evidence of cirrhosis, and contrast-enhanced CT and sonographic examinations perfo rmed within 1 week of each other. The sensitivities of CT and ultrason ography were determined by comparing the imaging findings with patholo gy findings from serially sectioned total hepatectomy specimens. A tot al of 40 hepatomas were detected pathologically in the 21 patients in our study population. CT identified 12 of 21 patients with hepatomas a nd detected 18 of 40 individual lesions (patient detection sensitivity = 57%, lesion detection sensitivity = 45%). Ultrasonography identifie d 14 of 21 patients with hepatomas and detected 21 of 40 individual le sions (patient detection sensitivity = 67%, lesion detection sensitivi ty = 51%). Combining the findings of CT and ultrasonography allowed id entification of 17 of 21 patients with hepatomas and detection of 24 o f 40 individual lesions (patient detection sensitivity = 80%, lesion d etection sensitivity = 60%). We conclude that CT and ultrasonography h ave a low sensitivity for the detection of hepatocellular carcinoma in patients with cirrhosis.