Detection of Primary Hepatic Malignancy in Liver Transplant Candidates: Prospective Comparison of CT, MR Imaging, US, and PET

Teefey, Sharlene A.; Hildeboldt, Charles C.; Dehdashti, Farrokh; Siegel, Barry A.; Peters, Marion G.; Heiken, Jay P.; Brown, Jeffrey J.; McFarland, Elizabeth G.; Middleton, William D.; Balfe, Dennis M.; Ritter, Jon H.

doi:10.1148/radiol.2262011980

Cited by 196 publications

(122 citation statements)

References 34 publications

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“…Eleven studies in this systematic review analyzed the accuracy of CT for the diagnosis of HCC [33][34][35]37,40,43,46,[48][49][50][51] (Supporting Table 5). Again, wide ranges were observed for the sensitivity (6%-100%) and the specificity (67%-100%), even though all studies except one 35 used the explanted liver as the gold standard.…”

Section: Question 3 What Are the Sensitivity And Specificity Of Nonimentioning

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Is tumor biopsy necessary?

et al. 2011

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Section: Question 3 What Are the Sensitivity And Specificity Of Nonimentioning

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“…Finally, 9 studies used MRI for the noninvasive diagnosis of HCC 32,40,43,46,48,[52][53][54][55] (Supporting Table 6). In all *The analysis was presented for 3 observers.…”

Section: Question 3 What Are the Sensitivity And Specificity Of Nonimentioning

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Is tumor biopsy necessary?

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“…Reported sensitivity values for CT range from 70 -80% (11)(12)(13), and MRI sensitivity of 84% was observed in a study with IV administered contrast agents (9). Thus, the traditional IV method of contrast agent delivery is inadequate for reliably detecting small HCC lesions.…”

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Comparison between intravenous and intraarterial contrast injections for dynamic 3D MRI of liver tumors in the VX2 rabbit model

Larson

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et al. 2006

Magnetic Resonance Imaging

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Purpose:To test the hypothesis that catheter-directed intraarterial (IA) contrast agent injection increases tumor enhancement and conspicuity compared to intravenous (IV) injection. Materials and Methods:Eight VX2 liver tumors were grown in five rabbits. After positioning a catheter in the hepatic artery, we performed 3D inversion recovery GRE MRI after IA and IV gadopentetate-dimeglumine contrast injections at doses of 0.04 and 0.1 mmol/kg, respectively. Peak enhancement (signal-to-noise ratio (SNR)) and conspicuity (contrastto-noise ratio (CNR)) were measured for each acquisition. Results:The peak SNR and CNR were 21.7 Ϯ 5.8 and 17.0 Ϯ 4.8 (mean Ϯ SD) after IA injection, and 16.9 Ϯ 10.2 and 6.2 Ϯ 2.6 after IV injection. The IA CNR was significantly greater than the IV CNR (P Ͻ 0.05), with a Ͼ60% increase in CNR for each tumor. For six of the eight tumors the IA SNR was greater than the IV SNR, but statistical significance was not achieved due to the small sample size of the study (P ϭ 0.07). Conclusion:We demonstrated the feasibility of using IA injection techniques to improve tumor conspicuity. This strategy could be employed to enhance the detection of small liver tumors or to conserve contrast agent in future MRI-guided transcatheter liver therapies.

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“…With this in mind, it should be emphasized that with conventional technology 16 and even with state-ofthe-art equipment, 17 we will always have some understaging, mostly caused by the failure to detect very small additional nodules less than 1 cm and/or microscopic vascular invasion. This was already emphasised years ago in the studies by Mazzaferro et al 6 and Llovet et al, 7 who reported this understaging after restrictive selection, but at the same time described its marginal impact on the recurrence rate after transplantation.…”

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