Detection of hepatocellular carcinomas and dysplastic nodules in cirrhoticlivers: Accuracy of helical CT in transplant patients

OBJECTIVE. The purpose of this study was to evaluate the diagnostic efficac y of three-phase helical dynamic CT in the detection and characterization o f hepatocellular carcinomas and dysplastic nodules in cirrhotic livers. SUBJECTS AND METHODS. Three-phase helical dynamic CT in 41 patients with li ver cirrhosis was evaluated prospectively before orthotopic liver transplan tation. The numbers of hepatocellular carcinomas and dysplastic nodules wer e assessed in the explanted livers and compared with pretransplantation CT findings. RESULTS. Examination of the explanted livers revealed 21 hepatocellular car cinomas in 15 patients and 23 dysplastic nodules in 10 patients. The size o f the hepatocellular carcinomas was 0.6-5.0 cm (mean, 1.9 cm), and that of the dysplastic nodules was 0.7-2.0 cm (mean, 1.0 cm). The use of helical dy namic CT enabled detection of 15 of 21 hepatocellular carcinomas (sensitivi ty, 71% )and nine of 23 dysplastic nodules (sensitivity, 39%). Patient sens itivity and specificity in the detection of hepatocellular carcinomas were 80% (12/15) and 96% (25/26), respectively, and for dysplastic nodules, 50% (5/10) and 97% (30/31), respectively. CONCLUSION. Three-phase helical dynamic CT is relatively insensitive for de tection of hepatocellular carcinomas and dysplastic nodules in cirrhotic li vers, especially for dysplastic nodules and hepatocellular carcinomas small er than 2 cm.