MALIGNANCIES IN PATIENTS WITH CIRRHOSIS - CT SENSITIVITY AND SPECIFICITY IN 200 CONSECUTIVE TRANSPLANT PATIENTS

PURPOSE: To determine the sensitivity and specificity of computed tomo graphy (CT) as a screening tool in patients with cirrhosis. MATERIALS AND METHODS: CT examinations were performed before liver transplantati on in 200 consecutive patients with cirrhosis. Scans were prospectivel y reviewed and compared with pathologic findings in the fresh serially sectioned whole livers. RESULTS: Pathologic evaluation revealed hepat ocellular carcinoma in 35 patients and cholangiocarcinoma in five. Mal ignancy was clinically suspected in 18 patients prior to imaging. CT d epicted tumor in 25 patients; tumor was identified only at pathologic study in 14 patients. Sensitivity of unenhanced and enhanced CT in det ection of malignancy was 63% and 68%, respectively, and specificity wa s 63% and 81%, respectively. Cysts and hemangiomas were found in only 10 and five patients, respectively. CONCLUSION: CT is insensitive for detection of neoplasms in the cirrhotic liver. Unsuspected malignant n eoplasms are encountered more frequently than cysts or hemangiomas. Se nsitivity of unenhanced CT for tumor detection is similar to that of e nhanced CT; unenhanced CT, however, is less specific for malignancy.