DIAGNOSTIC-VALUE AND TOLERANCE OF LIPIODOL-COMPUTED TOMOGRAPHY FOR THE DETECTION OF SMALL HEPATOCELLULAR-CARCINOMA - CORRELATION WITH PATHOLOGICAL EXAMINATION OF EXPLANTED LIVERS

Background/Aims: This study aimed to assess the tolerance and the real sensitivity of Lipiodol-computed tomography in the detection of small hepatocellular carcinoma by comparison with pathological examination of the explanted livers.Methods: Seventy-two patients with cirrhosis ( Child A=8, B=36, C=28) awaiting orthotopic liver transplantation under went Lipiodol-computed tomography to determine the presence, number an d location of possible hepatocellular carcinoma nodules, Before liver transplantation six patients had a presumed single hepatocellular carc inoma diagnosed by biopsy Liver transplantation was performed a mean o f 6 months after Lipiodol-computed tomography, Explanted livers were s ectioned at 0.8- to 1-cm intervals, Lipiodol-computed tomography stagi ng and pathologic findings were compared, Results: Pathologic studies showed 24 hepatocellular carcinoma nodules (diameter, 2-42 mm) not dia gnosed before liver transplantation in 14 of the 72 livers, Lipiodol-c omputed tomography detected 6 of these 24 nodules, but none of the dau ghter lesions (n=9) in the sis patients with a presumed single hepatoc ellular carcinoma, Lesion-by-lesion analysis revealed a sensitivity of 37%, Lipiodol-computed tomography falsely detected three additional n odules not confirmed by pathologic examination (1 haemangioma, 2 nondy splastic regenerating nodules), One Child C patient developed variceal bleeding within 2 days after injection of Lipiodol, Conclusions: Tole rance of this procedure was satisfactory, even in Child C patients, Li piodol-computed tomography has a low sensitivity in the detection of s mall hapatocellular carcinoma, These results must be considered when l iver resection or liver transplantation is proposed for the treatment of hepatocellular carcinoma.