Small hepatocellular carcinoma in patients undergoing liver transplantation: detection with CT after injection of iodized oil.

Abstract

To assess computed tomography (CT) with iodized oil for depiction of small hepatocellular carcinoma (HCC) before liver transplantation. Thirty-five consecutive cirrhotic patients underwent CT with iodized oil to determine the presence, number, size, and location of possible nodules. All patients underwent liver transplantation within 4 months after CT. Explanted livers were cut in 8-mm slices that corresponded to axial CT scan planes. Comparison between CT staging and pathologic findings was made. Pathologic studies showed 17 HCC nodules (diameter, 0.9-4.0 cm) in nine of the 35 livers. CT depicted nine of these 17 nodules. Lesion-by-lesion analysis revealed a sensitivity of 53%; CT falsely depicted three additional nodules not confirmed with pathologic findings. Patient-by-patient analysis revealed an 89% sensitivity and an 88% specificity. CT with iodized oil, when assessed lesion by lesion, has a low sensitivity. These results must be considered when liver resection is proposed for HCC.