Detection of small hepatocellular carcinomas in cirrhotic livers using iodised oil computed tomography

Abstract

Background: 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).

Aims: To assess the sensitivity of iodised oil computed tomography (IOCT).

Patients and methods: A 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.

Results: Eleven 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.

Conclusion: IOCT 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.

Figure 1

: Focal (A) and heterogeneous (B) iodised oil deposition on computed tomography.

Figure 2

: (A) Naked eye appearance of a liver slice containing two HCCs (central white nodules), one with haemorrhagic change (focal black discolouration). (B) Corresponding soft tissue radiograph demonstrating iodised oil uptake (central opacity) in one of the two cancers.

Figure 2

: (A) Naked eye appearance of a liver slice containing two HCCs (central white nodules), one with haemorrhagic change (focal black discolouration). (B) Corresponding soft tissue radiograph demonstrating iodised oil uptake (central opacity) in one of the two cancers.