Hepatocellular carcinoma: Are combined CT during arterial portography and CT hepatic arteriography in addition to triple-phase helical CT all necessary for preoperative evaluation?

PURPOSE: To determine whether the combination of CT during arterial portogr aphy (CTAP) and CT hepatic arteriography (CTHA) provides an added benefit t o triple-phase helical CT (THCT) alone in the preoperative evaluation of he patocellular carcinoma (HCC). MATERIALS AND METHODS: Fifty-two consecutive patients with pathologically p roved HCC underwent THCT (hepatic arterial, portal venous, and delayed phas es) and combined CTAP and CTHA. Two radiologists reviewed the images in thr ee sessions: first the THCT images alone, then with the CTAP images, and fi nally all three sets of images. RESULTS: There were 73 pathologically confirmed HCCs. Among 72 lesions cons idered as HCC at THCT, 69 were proved to be HCCs. Of the additional 37 nodu les interpreted as HCC at CTAP, only one was confirmed as such. Among the a dditional 20 lesions presumed to be HCC at combined CTAP and CTHA, only two were proved to be HCCs. The sensitivity was 94% (69 of 73 lesions) at THCT , 96% (70 of 73) with additional CTAP, and 97% (71 of 73) with all three mo dalities. The positive predictive value was 96% (69 of 72) at THCT, 65% (70 of 107) with additional CTAP, and 80% (71 of 89) with all three modalities . CONCLUSION: The use of CTAP and CTHA, in addition to being invasive and cos tly, resulted in an unacceptably high false-positive rate without a substan tial increase in sensitivity. Therefore, CTAP and CTHA are not recommended for preoperative evaluation of HCC; THCT alone is preferred.