Correlation between imaging and pathologic findings in explanted livers of hepatocellular carcinoma cases

Purpose We sought investigate the accuracy of preoperative computed tomography angiography (CTA) and magnetic resonance imaging (MRI) to evaluate tumor-related prognostic factors, including tumor size, number, portal vein (PV) thrombosis, and bile duct invasion. Materials and Methods From March 2006 to October 2008, we enrolled 57 patients with hepatocellular carcinoma (HCC) who were undergoing liver transplantation at our institute. Imaging was performed with multidetector 64 slice CTA and MRI within 1 month preoperatively. Imaging findings including tumor size, number, PV thrombosis, and bile duct invasion were correlated with histopathologic features from the explanted livers. Results We included 128 HCCs in 57 patients in this study. The sensitivities to detect tumor number and size were 83.6% and 88.8% for CTA, and 75.8% and 88.7% for MRI. In addition, CTA and MRI were both accurate to determine whether patients were beyond or within the Milan and UCSF criteria. Fifteen patients with PV microthrombosis and 1 with bile duct microinvasion were not found on CTA or MRI preoperatively; negative predictive value of PV microthrombosis and bile duct microinvasion were 73.68% and 98.25%, respectively. During follow-up, 2 patients experienced recurrence, one of which was associated with PV microthrombosis, and 4 patients died of causes unrelated to HCC. Conclusion CTA and MRI were both accurate to determine whether patients fit within the Milan or UCSF criteria, but CTA was slightly better than MRI to evaluate tumor number and size. However, pretransplant diagnostic pitfalls were PV microthrombosis and bile duct microinvasion.