Dysplastic nodules and hepatocellular carcinoma: Sensitivity of digital subtraction hepatic arteriography with whole liver explant correlation

Purpose: The purpose of this work was to determine the sensitivity of hepat ic digital subtraction arteriography (DSA) for the detection of hepatocellu lar carcinoma (HCC) and dysplastic nodules (DNs) when compared with patholo gical finding-a from whole liver explants. Method: Twenty-one patients 30-72 years old (mean 54 years) with cirrhosis and known or clinically suspected HCC (20 prior to chemoembolization) under went hepatic DSA with subsequent transplantation within 80 days (mean 32 da ys). The prospective DSA report was compared with pathologic findings from explanted livers. Results: Overall, DSA detected 31 of 95 HCC lesions for a sensitivity of 33 %. Of these 31 lesions, 28 were hypervascular and 3 were hypovascular. DSA detected all six HCCs measuring >5 cm, all six HCCs measuring 3-5 cm, and a ll five HCCs 2-3 cm, resulting in a sensitivity of 100% (17/17) for HCC >2 cm. DSA detected 7 of 18 HCCs measuring 1-2 cm (sensitivity 39%) and 7 of 6 0 HCCs less than or equal to 1 cm (sensitivity 12%). Overall sensitivity fo r DSA in detection of HCC less than or equal to 2 cm was 18% (14/78 lesions ). None of 17 DNs (0.2-1.5 cm in size) was identified on DSA. Conclusion: DSA is insensitive to small HCC (less than or equal to 2 cm), c arcinomatosis arising within nodules, and DN.