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J Saada
a Department of Radiology, b Department of Surgery, c Department
of Pathology, d Department of
Medicine
Correspondence to: Professor
B R Davidson, Department of Surgery, Royal Free Hospital and
Medical School, Pond St, London NW3 2QG, UK. Accepted for publication 20 February 1997 Background Keywords:
liver cirrhosis;
transplantation;
hepatocellular
carcinoma;
iodised oil;
computed tomography
The detection of hepatocellular cancers
(HCC) is a major role of preoperative imaging in patients with end
stage liver disease being considered for orthotopic liver
transplantation (OLT).
AimsTo assess the sensitivity of iodised oil
computed tomography (IOCT).
Patients and methodsA prospective evaluation in
50 consecutive patients undergoing OLT included ultrasound scan,
contrast enhanced CT, angiography (with intra-arterial injection of
iodised oil), and a second CT (IOCT) 10 days later. Following
transplantation the explant liver was serially sectioned for
pathological evaluation. Soft tissue radiographs of the liver slices
were used to match histological lesions with CT findings.
ResultsEleven patients were excluded due to
protocol violations. Of the remaining 39, histological evaluation
revealed no cancers in 33 explant livers, in keeping with negative
preoperative imaging. Six explant livers contained 55 HCCs, 84% of
which were less than 1 cm in diameter. Pretransplant IOCT detected 3/6
patients with cancer (50%) but only 7% of cancerous lesions.
Ultrasound, contrast CT, and angiography each detected 2/6 patients
with cancer and 4% of cancerous lesions.
ConclusionIOCT is an insensitive method for the
detection of small HCCs in livers with advanced cirrhosis but in this
study was slightly superior to ultrasound, CT, and angiography.
(GUT 1997;41:404-407)
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