Detection of small hepatocellular carcinomas in cirrhotic liversusing iodised oil computed tomography

Background—The detection of hepatocellular cancers(HCC) is a major role of preoperative imaging in patients with endstage liver disease being considered for orthotopic livertransplantation (OLT).
Aims—To assess the sensitivity of iodised oilcomputed tomography (IOCT).
Patients and methods—A prospective evaluation in50 consecutive patients undergoing OLT included ultrasound scan,contrast enhanced CT, angiography (with intra-arterial injection ofiodised oil), and a second CT (IOCT) 10 days later. Followingtransplantation the explant liver was serially sectioned forpathological evaluation. Soft tissue radiographs of the liver sliceswere used to match histological lesions with CT findings.
Results—Eleven patients were excluded due toprotocol violations. Of the remaining 39, histological evaluationrevealed no cancers in 33 explant livers, in keeping with negativepreoperative imaging. Six explant livers contained 55 HCCs, 84% ofwhich were less than 1 cm in diameter. Pretransplant IOCT detected 3/6patients with cancer (50%) but only 7% of cancerous lesions.Ultrasound, contrast CT, and angiography each detected 2/6 patientswith cancer and 4% of cancerous lesions.
Conclusion—IOCT is an insensitive method for thedetection of small HCCs in livers with advanced cirrhosis but in thisstudy was slightly superior to ultrasound, CT, and angiography.

Keywords:liver cirrhosis; transplantation; hepatocellularcarcinoma; iodised oil; computed tomography