Malignancies in patients with cirrhosis: CT sensitivity and specificity in 200 consecutive transplant patients

Abstract

Purpose: To determine the sensitivity and specificity of computed tomography (CT) as a screening tool in patients with cirrhosis.

Materials and methods: CT examinations were performed before liver transplantation in 200 consecutive patients with cirrhosis. Scans were prospectively reviewed and compared with pathologic findings in the fresh serially sectioned whole livers.

Results: Pathologic evaluation revealed hepatocellular carcinoma in 35 patients and cholangiocarcinoma in five. Malignancy was clinically suspected in 18 patients prior to imaging. CT depicted tumor in 25 patients; tumor was identified only at pathologic study in 14 patients. Sensitivity of unenhanced and enhanced CT in detection of malignancy was 63% and 68%, respectively, and specificity was 63% and 81%, respectively. Cysts and hemangiomas were found in only 10 and five patients, respectively.

Conclusion: CT is insensitive for detection of neoplasms in the cirrhotic liver. Unsuspected malignant neoplasms are encountered more frequently than cysts or hemangiomas. Sensitivity of unenhanced CT for tumor detection is similar to that of enhanced CT; unenhanced CT, however, is less specific for malignancy.