Angelo Luca MD, Abstract Co-Author: Nothing to Disclose

Mariapina Milazzo, Abstract Co-Author: Nothing to Disclose

Settimo Caruso MD, Abstract Co-Author: Nothing to Disclose

Gianluca Marrone MD, Presenter: Nothing to Disclose

Giuseppe Mamone MD, Abstract Co-Author: Nothing to Disclose

Luigi Maruzzelli MD, Abstract Co-Author: Nothing to Disclose

Roberto Miraglia MD, Abstract Co-Author: Nothing to Disclose

et al, Abstract Co-Author: Nothing to Disclose

et al, Abstract Co-Author: Nothing to Disclose

The aim of this study was to assess the prevalence and the diagnostic performance of radiological patterns for detection of HCC in cirrhotic patients imaged with state-of-art technologies and compare the accuracy of radiological staging to pathological staging on explanted livers.

132 cirrhotic patients waiting for transplantation were evaluated with state-of-art MDCT and MRI and results matched with histopathology on liver explants. Statistical analyses were made using chi-square test, positive predictive value (PPV) and positive likelihood ratio (PLR).

Histopathology disclosed 168 HCC and 28 no-HCC lesions. Images found 174 nodules: 33 lesions were ≤20mm with arterial hypervascularity and washout; 36 were >20mm with arterial hypervascularity and washout; 65 had only-hypervascular pattern; 17 were ≥20mm with no-hypervascular pattern; 21 had necrosis >90% as result of percutaneous treatment. PPV for HCC diagnosis of hypervascular nodules with washout >20mm and ≤20mm were 100% and 92% respectively; overall PPV and PLR were 96% and 5.95, respectively. PPV for only-hypervascular nodules 20mm were 30%, 62% and 71% respectively. PPV for no-hypervascular nodule >20mm was 76%. Images identified 77% of HCC however, sensitivity decreased with size and using more stringent image criteria. Rigorous image criteria for the diagnosis of HCC established an accurate stage in 55% of patients, underestimation in 44% and overestimation in 1%.

In cirrhotic patients, any hypervascular lesions with washout identified at a single imaging technique, regardless of size, can be confidentially considered HCC. Only-hypervascular lesions >10mm and no-hypervascular nodules ≥20mm should be always regarded as suspicious for HCC and an additional imaging technique and/or a lesion biopsy should be recommended. Even using state-of-the-art imaging technologies and new scanning protocols, the diagnosis of HCC based on rigorous image criteria has a low sensitivity for detection of small HCC; however, the use of rigorous HCC criteria avoids the risk of overestimate the pathological stage.

Our data can be used to stage more accurately HCC patients with imaging.

Luca, A, Milazzo, M, Caruso, S, Marrone, G, Mamone, G, Maruzzelli, L, Miraglia, R, et al, , et al, , Hepatic Nodules Detected in Cirrhotic Patients Using High-performance MDCT and MRI: A Radiological-Pathological Correlation on Explanted Livers.  Radiological Society of North America 2007 Scientific Assembly and Annual Meeting, November 25 - November 30, 2007 ,Chicago IL. http://archive.rsna.org/2007/5003944.html