Spiral computed tomography during arterial portography of the liver: Correlations between radiological and intraoperative findings and evaluation of operability.

Purpose: To evaluate the accuracy of spiral computed tomography during arte rial portography (SCTAP) in the detection, localization, and resectability of liver tumors in a correlative study between radiology and intraoperative findings. Method and Materials: Retrospectively, SCTAP images of 168 conse cutive patients before liver tumor resection were analyzed. The SCTAP studi es (100 mt lopromid 300 by automated injector with a flow of 3ml/s; slice t hickness, table feed and reconstruction index 5 mm each; scan-delay 30 s; 1 20 kV; 250 mAs) were evaluated for the detection, localization, and resecta bility of focal liver lesions by three experienced radiologists in consensu s and were correlated with histopathological and intraoperative findings wh ere available (59/168). Results: The sensitivity of SCTAP for the detection of liver tumors was 91% for all lesions and 84% for lesions < 1 cm. The sp ecificity was only 19% due to a high Fate of false-positive lesions (30%) a nd preselection effects. Typical pitfalls in false positive lesions were in homogeneous liver perfusion near the portal vein, the falciforme ligament, and the gallbladder (19/42). In 30% of the patients SCTAP correctly diagnos ed inoperability, in 23% the intraoperative tumor expansion was larger than expected from SCTAP images, which would have changed operability. Conclusi on: The SCTAP has a high sensitivity in the detection and localization of l iver tumors and is a valuable method in the preoperative diagnostic precedu re. The method is limited by many false-positive lesions often due to inhom ogeneous liver perfusion and the insufficient evaluation of local tumor spr ead. Therefore, SCTAP should be replaced by MRI in the near future.