This study shows that both EASL and AASLD noninvasive recall strategies for nodules of 10-30 mm in the cirrhotic liver, based on the vascular pattern of nodules, have a false-negative rate of approximately 20%. SPIO-MR may increase the diagnostic potential of noninvasive techniques, contributing to the diagnosis of HCC lacking a typical vascular pattern.

Chronic hepatitis C represents a major clinical problem after liver transplantation, but factors influencing the recurrent disease have not been well characterized. We analyzed the clinical records of all the patients transplanted for hepatitis C virus (HW-related liver disease in our Center between 1991 and 1997. Eighty consecutive HCV-positive (+) patients (60 men, ages 28 to 64) survived more than 1 month after transplantation and were followed for a median of 45 months. Diagnosis of recurrent chronic hepatitis C was made in 38 patients (47.5%), of whom 22 had moderate/severe chronic hepatitis. Decompensated cirrhosis occurred in six patients (7.5%).N o difference in patient survival was found between patients with and without hepatitis C recurrence. N o association was found between recurrent hepatitis C and presumed risk factors. The method of tapering off corticosteroids was significantly associated with both hepatitis C recurrence and the severity of hepatitis. In patients receiving a higher daily prednisone dose, 12 months after transplantation, the proportion of recurrent hepatitis C was The aim of our study was to evaluate the clinical records of all patients who underwent transplantation in our single center during the last decade to outline the features of recurrent hepatitis C and, possibly, to identi!+ the risk factors eventually associated with the more severe forms of this disease. 35 Patients and Methods Patient PopulationBetween January, 1991 and December, 1997, 25 1 adult patients underwent OLT at the Department of Surgery and Transplantation, University of Bologna, ofwhom 97 received liver graft for end-stage liver disease secondary to HCV infection. Of these patients, 12 with a concomitant hepatitis B virus (HBV) infection, one with de novo HBV infection after OLT, and four who died within 30 days after surgery were excluded from the analysis. Therefore, our study population included 80 consecutive patients (60 men and 20 women, ages ranging from 28 to 64 years), who underwent transplatation for HCV-related liver disease, who survived more than 1 month after OLT, with well-established HCV infection (anti-HCV and HCV-RNA positivity by polymerase chain reaction) before and after after liver transplant, Clinical and laboratory data were available for the complete series of patients at the time of transplantation and subsequently.

Brain water apparent diffusion coefficient is increased in patients with chronic liver disease and may be useful in monitoring patients with hepatic encephalopathy.

The best prioritization of patients with hepatocellular carcinoma (HCC) waiting for liver transplantation under the model for end-stage liver disease (MELD) allocation system is still being debated. We analyzed the impact of a MELD adjustment for HCC, which consisted of the addition of an extra score (based on the HCC stage and waiting time) to the native MELD score. In the HCC-MELD era, the cumulative dropout risk at 6 months was 17.6% for patients with HCC versus 22.3% for those patients without HCC (P ϭ NS), similar to that in the UNOS-CTP era. The cumulative probability of transplantation at 6 months was 70.3% versus 39.0% (P ϭ 0.005), being higher than that in the UNOS-CTP era for patients with HCC (P ϭ 0.02). At the end of the HCC-MELD era, 12 patients with HCC (29.3%) versus 57 without HCC (58.8%) were still on the list (P ϭ 0.001). Both native and adjusted MELD scores were higher (P Ͻ 0.05) and progressed more in patients with HCC who dropped out than in those who underwent transplantation or remained on the list (the initial-final native MELD scores were 17. 3-23.1, 15.5-15.6, and 12.8-14.1, respectively). The patients without HCC remaining on the list showed stable MELD scores (initial-final: 15.1-15.4). In conclusion, the present data support the strategy of including the native MELD scores in the allocation system for HCC. This model allows the timely transplantation of patients with HCC without severely affecting the outcome of patients without HCC.

Real-time contrast-enhanced ultrasonography provides sensitive and specific criteria for the differential diagnosis between benign and malignant liver lesions, and in most cases it may replace more expensive and invasive imaging techniques.