Pretransplantation surveillance for possible hepatocellular carcinoma in patients with cirrhosis: Epidemiology and CT-based tumor detection rate in 430 cases with surgical pathologic correlation
Ms. Peterson et al., Pretransplantation surveillance for possible hepatocellular carcinoma in patients with cirrhosis: Epidemiology and CT-based tumor detection rate in 430 cases with surgical pathologic correlation, RADIOLOGY, 217(3), 2000, pp. 743-749
Citations number
23
Categorie Soggetti
Radiology ,Nuclear Medicine & Imaging","Medical Research Diagnosis & Treatment
PURPOSE: To determine the prevalence of clinically unsuspected hepatocellul
ar carcinoma (HCC) with advanced cirrhosis and assess the sensitivity of he
lical computed tomographic (CT) surveillance for tumor detection in these p
atients.
MATERIALS AND METHODS: Prospective direct correlation of CT findings with e
xplanted liver specimen findings was performed in 430 transplant recipients
with cirrhosis. The prevalence of clinically unsuspected HCC according to
liver disease cause was evaluated. Serum ol-fetoprotein (AFP) values in pat
ients with and those without tumor were recorded. Prospective and retrospec
tive CT tumor detection was evaluated with respect to CT technique and time
from CT to transplantation.
RESULTS: HCC was found in 59 (14%) of 430 transplant recipients without sus
picion of tumor before referral for transplantation. HCC was most prevalent
with hepatitis B (27%) and hepatitis C (22%). Serum AFP values were not se
nsitive for detection of most small tumors. With triphasic helical CT, the
prospective and retrospective rates of identifying patients with tumor were
59% and 68%, respectively; the prospective and retrospective tumor nodule
detection rates were 37% and 44%, respectively, tumor detection rates were
highest with CT performed within 67 days before transplantation.
CONCLUSION: Clinically unsuspected HCC is most prevalent with cirrhosis sec
ondary to hepatitis B or C, and, when evaluated at CT, is best detected wit
h triphasic contrast material-enhanced helical imaging performed within 67
days before transplantation.