BIPHASIC SPIRAL COMPUTED-TOMOGRAPHY FOR DETECTION OF HEPATOCELLULAR-CARCINOMA BEFORE RESECTION OR ORTHOTOPIC LIVER-TRANSPLANTATION

RATIONALE AND OBJECTIVES. The authors correlate computed tomography (C T) findings in biphasic spiral technique with histopathology in patien ts with hepatocellular carcinoma (HCC) who had undergone liver resecti on (LR) or orthotopic liver transplantation (OLT), METHODS. Preoperati ve biphasic spiral CT findings in 33 consecutive patients (23 men, 10 women, aged 43-74 years; LR group: n = 17; OLT group; n = 16) with Liv er cirrhosis and HCC were reviewed retrospectively by consensus of two radiologists and correlated with pathology from liver specimens, RESU LTS. Of the 16 patients in the OLT group with 1 to 5 confirmed HCC les ions (total lesions: 29; mean lesion diameter: 2 cm; range: 0.6-5.0 cm ), CT before OLT depicted 22 lesions in 15 patients (sensitivity for l esions with a diameter of 0.5-1.0 cm, 20 %; for lesions 1.1-2.0 cm, 82 %; and for lesions 2.1-3.0 cm and >3.0 cm, 86% and 100%, respectively) , Among the 17 patients in the LR group (total lesions: 21; mean lesio n diameter: 5.4 cm; range: 1.0-11.0 cm), CT detected 18 lesions, Lesio n-by-lesion sensitivity, as correlated with pathology, was calculated at 76% and 86% in the OLT and LR groups, respectively (overall sensiti vity, 80%), The diameter of CT detected lesions, compared with liver s pecimens, corresponded in 90% of lesions (maximum deviation, 15%), Cha racteristic CT findings of HCC ineluded unenhanced hypoattenuating foc al liver lesions (32 lesions), with hyperattenuation (38 lesions) in t he arterial phase of contrast material administration, CONCLUSIONS. Bi phasic spiral CT for preoperative HCC detection correlated with pathol ogy in 80%, thus proving this technique to represent a sensitive imagi ng modality for pretherapeutic evaluation of HCC.