Diagnostic Accuracy of Multi-/Single-Detector Row CT and Contrast-Enhanced MRI in the Detection of Hepatocellular Carcinomas Meeting the Milan Criteria before Liver Transplantation

Abstract

Liver transplantation has been considered to be the only causal treatment for liver cirrhosis patients with hepatocellular carcinoma (HCC) due to its theoretical advantage of eliminating both the tumor and liver disease. However, because of the shortage of donor organs, it is strongly recommended that liver transplantations should be performed on cirrhotic patients with HCCs only when the patients meet the predetermined criteria in terms of number and extent of HCCs. Imaging is thus decisive in the patient inclusion or exclusion from transplantation lists. The imaging techniques used are CT, MRI and ultrasonography. The latter has been proven to be ineffective for HCC surveillance in transplant recipients because of its heavy operator dependence and unreliable detection of small and intermediately sized HCCs. The purpose of this article, then, is to systematically review the diagnostic performances of single-/multidetector row CT, dynamic gadolinium-enhanced MRI, superparamagnetic iron oxide (SPIO)-enhanced MRI and double-contrast MRI using both gadolinium and SPIO for the detection of HCCs with special emphasis on liver transplantation.

Actual therapeutic efficacy of pre-transplant treatment on hepatocellular carcinoma and its impact on survival after salvage living donor liver transplantation

“…Previously, Kim et al 19 reported that a viable tumor volume ratio greater than 10% after preLT therapy was a significant prognostic factor. Pompili et al 20 also reported that 58.7% of HCC had partial necrosis after percutaneous ablation procedures and the effect depended on the size of HCCs.…”

Asian Pacific Association for the Study of the Liver consensus recommendations on hepatocellular carcinoma

“…The operative characteristics of CT are comparable, whereas MRI is more sensitive. The performance of CT and MRI is affected by the size of the lesions [204,205]. Although CT and MRI are reported to have a sensitivity of 60-94.4% and 58.5-93%, respectively, in tumors larger than 1 cm, their sensitivities for detecting tumors smaller than 1 cm are reduced by 33-45 and 33-67%, respectively [204,[206][207][208].…”

“…The performance of CT and MRI is affected by the size of the lesions [204,205]. Although CT and MRI are reported to have a sensitivity of 60-94.4% and 58.5-93%, respectively, in tumors larger than 1 cm, their sensitivities for detecting tumors smaller than 1 cm are reduced by 33-45 and 33-67%, respectively [204,[206][207][208]. Furthermore, small, arterially enhancing nodules are common in the cirrhotic liver, and majority of these nodules are benign [209][210][211].…”

“…Several studies demonstrated that SPIO-enhanced MRI is useful in differentiating small HCCs from small, arterially enhancing pseudolesion [214,218]. When considering only studies with whole-liver explant, the highest performance was achieved using double-contrast liver MRI with both gadolinium and SPIO, with sensitivity ranging from 78 to 80%, compared with multidetector-row CT (MDCT) with 65-79%, SPIOenhanced MRI with 66-82% and dynamic MRI with 55-95% [204]. A more recent study of MRI with explant pathologic correlation demonstrated that gadobenate dimeglumine, which is a hepatobiliary agent, enhanced MRI has a sensitivity of 80-85% and a positive predictive value of 65-66% in the detection of HCC but is of limited value for detecting and characterizing lesions smaller than 1 cm [219].…”

11C-Acetate and 18F-FDG PET/CT for Clinical Staging and Selection of Patients with Hepatocellular Carcinoma for Liver Transplantation on the Basis of Milan Criteria: Surgeon’s Perspective

“…It is well known, however, that their sensitivity for the detection of HCC is suboptimal in the presence of architectural distortion caused by severe cirrhosis in pretransplant patients, mostly reported to be about 60%-70% (10,11). In recent years, double-contrast MRI with both gadolinium and superparamagnetic iron oxide has been reported to have significantly improved the detection of HCC in cirrhotic livers, with a sensitivity of 75%-80% (12)(13)(14). Besides CT and MRI, PET has also been used.…”