Tumor diagnosis in the adult liver transplant candidate

Abstract

Hepatic transplantation has emerged as a potentially curative treatment of certain malignant hepatic neoplasms such as hepatocellular carcinoma, bile duct carcinoma, fibrolamellar hepatocellular carcinoma, metastases from neuroendocrine tumors, and epithelioid hemangioendothelioma. In the early years of hepatic transplantation, there was great enthusiasm to cure patients with unresectable hepatobiliary malignancy. This early enthusiasm was tempered by the unfavorable outcome of transplantation in advanced cases of malignancy and the organ-donor shortage. Presently, patients have to be selected with predictable likelihood for long-term survival. Pre-transplantation imaging is indispensable for detection, characterization, staging, and surgical road-mapping before the procedure. The present article focuses on the role of imaging modalities in these different aspects of preoperative assessment.

Liver transplantation for cholangiocellular carcinoma: Analysis of a single-center experience and review of the literature

“…Although the diagnostic accuracy of such modalities as ultrasound, CT, and magnetic resonance imaging is high for IH lesions, these modalities are far less accurate for EH ductal lesions. 44,45 Consequently, most centers, including our own, rely on cholangiograms, endoscopic duct biopsies and brushings, and intraoperative frozen sections to diagnose CCC. These latter modalities are notoriously inaccurate in the diagnosis of tumors of bile duct origin.…”

Malignant focal hepatic lesions complicating underlying liver disease: dual-phase contrast-enhanced spiral CT sensitivity and specificity in orthotopic liver transplant patients

“…As a result, contrast-enhanced dual-phase spiral CT presently has an undisputed role as a screening modality for suspected focal liver disease [3,4,5,6].…”