Hepatocellular carcinoma in patients who undergo liver transplantation: sensitivity of CT with iodized oil.

Spreafico, Carlo; Marchianò, Alfonso; Mazzaferro, Vincenzo; Frigerio, Laura; Regalia, Enrico; Lanocita, Rodolfo; Patelli, Gianluigi; Andreola, Salvatore; Garbagnati, F; Damascelli, B

doi:10.1148/radiology.203.2.9114104

Cited by 54 publications

(26 citation statements)

References 0 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…First, there is a general trend toward reduced detection ability with both imaging techniques as the tumors become smaller and more differentiated. This observation is in line with that reported by Spreafico et al 31 for Lipiodol CT and by Ohashi et al 37 for dynamic incremental CT. Nonetheless, the sensitivity of helical CT for well-differentiated HCC is superior to that of Lipiodol CT or DSA, especially when tumors are small, whereas Lipiodol CT shows sensitivity superior to that of helical CT in detecting small but moderately to poorly differentiated HCCs.…”

Section: Discussionsupporting

confidence: 93%

Value of Lipiodol Computed Tomography and Digital Subtraction Angiography in the Era of Helical Biphasic Computed Tomography as Preoperative Assessment of Hepatocellular Carcinoma

Nakayama¹,

Imamura²,

Matsuyama³

et al. 2001

Annals of Surgery

View full text Add to dashboard Cite

ObjectiveTo compare the diagnostic accuracies of Lipiodol computed tomography (CT) and helical biphasic CT as preoperative imaging modalities for hepatocellular carcinoma (HCC). Summary Background DataLipiodol CT after digital subtraction angiography has long been used as a highly sensitive imaging modality for HCC. The recent advent of helical CT has allowed scanning the entire liver during both the arterial and portal venous phase of contrast enhancement. MethodsThe authors analyzed data from 164 patients who underwent hepatic resection for HCC to calculate the sensitivity and specificity of these modalities. Findings of intraoperative ultrasonography followed by histologic confirmation were set as the gold standard. ResultsAlthough sensitivity decreased with both modalities as tumors became small and well differentiated, helical CT showed a higher sensitivity than Lipiodol CT in detecting well-differentiated HCC nodules smaller than 2 cm. In contrast, Lipiodol CT was superior to helical CT for the detection of small but moderately to poorly differentiated nodules. The overall sensitivity of helical CT was higher than that of Lipiodol CT. These findings suggest that helical CT is superior in delineating early HCC, whereas Lipiodol CT is specific to the detection of intrahepatic metastases. In terms of specificity, helical CT was superior to Lipiodol CT. ConclusionsHelical CT and Lipiodol CT are complementary modalities. At present, helical biphasic CT does not obviate the need for invasive techniques such as angiography and Lipiodol CT as preoperative examinations for HCC.Advances in various imaging modalities including ultrasonography and computed tomography (CT) have facilitated the detection of hepatocellular carcinoma (HCC) in a preclinical stage.1 As a result, the resectability of HCC has markedly increased, thereby significantly improving survival during the past two decades.2-5 HCC nodules are often multifocal and frequently accompanied by intrahepatic metastatic nodules.6 -8 Underestimation of these lesions may lead to inappropriate surgical resection. Therefore, accurate preoperative imaging evaluation of HCC nodules is essential for selecting appropriate patients for surgical intervention and for determining the extent of hepatectomy. Because typical HCCs are hypervascular tumors that have only an hepatic arterial blood supply (i.e., there is no portal venous

show abstract

Section: Discussionsupporting

confidence: 93%

Value of Lipiodol Computed Tomography and Digital Subtraction Angiography in the Era of Helical Biphasic Computed Tomography as Preoperative Assessment of Hepatocellular Carcinoma

Nakayama¹,

Imamura²,

Matsuyama³

et al. 2001

Annals of Surgery

View full text Add to dashboard Cite

show abstract

“…Comparing the results of imaging modalities with the histopathologic data provides a clearly more precise assessment of the value of these methods than the usually performed comparison of radiologic modalities with a gold standard or the pathologic assessment of only a part of the liver after partial hepatic resection. 20 -24 Recently some authors have reported tumor detection rates of 37% to 71% by multiphasic HCT in transplant patients, 7,20 -23 a sensitivity of 58% for CT with iodized oil 24,27 and a sensitivity of 85% for CT during arterial portography. 24 Krinksy et al 28 observed disappointing results of gadolinium-enhanced magnetic resonance imaging compared with pathologic examination of explanted livers (HCC tumor detection rate 55%).…”

Section: Discussionmentioning

confidence: 99%

Accuracy of Multiphasic Helical Computed Tomography and Intraoperative Sonography in Patients Undergoing Orthotopic Liver Transplantation for Hepatoma: What is the Truth?

Zacherl

Pokieser²,

Wrba³

et al. 2002

Annals of Surgery

View full text Add to dashboard Cite

ObjectiveTo determine the real value of liver imaging in cirrhosis by macro-and histomorphologic examination of the entire organ after orthotopic liver transplantation for hepatocellular carcinoma (HCC). Summary Background DataIn comparative studies, a virtual sensitivity of up to 94% is described for helical computed tomography in HCC staging. The tumor detection rate of intraoperative ultrasonography (IOUS) is reported to be almost 100%. MethodsThis prospective observational study comprised 23 patients with HCC in cirrhosis admitted for orthotopic liver transplantation. Results of preoperative triphasic helical computed tomography (HCT) and IOUS were correlated with histopathologic results after 3-mm-slicing of the explanted liver. ResultsOverall, 179 liver segments were examined by HCT, IOUS, and MHM. Fifty-two malignant lesions and 10 dysplastic nodules were revealed by MHM. Using HCT, 13 HCCs could not be identified in 8 patients and 15 results were falsely positive in 10 patients. The detection rate of dysplastic nodes was 40% for HCT and 60% for IOUS. IOUS missed four HCCs in four patients and had six false-positive results in six patients. In a segment-based analysis, the overall accuracy of IOUS was significantly higher for IOUS (95.5%) versus HCT (89.9%). In the lesion-by-lesion analysis, the sensitivity was 92.3% for IOUS and 75.0% for HCT, with a significant difference.

show abstract

“…7 Lipiodol CT has a greater accuracy for tumor identification than either CT or angiography alone. 8,9 Unfortunately, none of the imaging modalities is perfect, and even with multiple investigations, comparison of the imaging studies with pathological tumor assessment after removal shows that tumors are understaged preoperatively in 25% or more of the cases. 10 Therefore, it is not uncommon for surgery to be performed for lesions that ultimately prove to be more extensive than indicated by preoperative investigations.…”

Section: Hcc With Cirrhosismentioning

confidence: 99%

Surgery and transplantation for hepatocellular cancer

Wall¹,

Marotta

2000

Liver Transpl

View full text Add to dashboard Cite

Hepatocellular carcinoma in patients who undergo liver transplantation: sensitivity of CT with iodized oil.

Cited by 54 publications

References 0 publications

Value of Lipiodol Computed Tomography and Digital Subtraction Angiography in the Era of Helical Biphasic Computed Tomography as Preoperative Assessment of Hepatocellular Carcinoma

Value of Lipiodol Computed Tomography and Digital Subtraction Angiography in the Era of Helical Biphasic Computed Tomography as Preoperative Assessment of Hepatocellular Carcinoma

Accuracy of Multiphasic Helical Computed Tomography and Intraoperative Sonography in Patients Undergoing Orthotopic Liver Transplantation for Hepatoma: What is the Truth?

Surgery and transplantation for hepatocellular cancer

Contact Info

Product

Resources

About