Abdomen, Liver, Oncology, CT, MR, Diagnostic procedure, Surgery, Transplantation
G. Besutti, A. Pecchi, M. De Santis, G. Tarantino, F. Di Benedetto, P. Torricelli; Modena/IT
Liver Transplantation (LT) is the preferred treatment for selected patients with hepatocellular carcinoma (HCC),
however a debate still exists over which patients should be considered for LT.
The Milan criteria,
first described in 1996 (1) and widely adopted,
have been recently considered too restrictive and expanded selection criteria have been proposed (2).
with the prognostic relevance of tumor size and number of lesion,
preoperative staging is crucial for patient selection based on the above-mentioned criteria and organ allocation.
Both contrast-enhanced dynamic multidetector Computed Tomography (MDTC) and Magnetic Resonance Imaging (MRI) are widely used in the detection and pretransplantation staging of HCC.
concerns regarding the accuracy of pretransplantation imaging in both diagnosis and staging remain.
The sensitivity of MDTC and dynamic MRI for HCC detection ranges from 50-89% and 61-91%,
as reported by previois studies (3-5).
Previous locoregional therapies,
in particular transarterial chemoembolization (TACE),
represent one of the major causes of false-negative and false-positive findings,
as the difficulty in the differentiation of totally necrotic nodules from viable HCCs limits mainly the accuracy of CT but remains also on MRI (6).
Recent studies have demonstrated a recurrence in 8-15% of HCC patients after LT (7).
Tumor size and vascular involvement are known to be the most important prognostic factors for tumor recurrence,
while the role of tumor differentiation is still controversial (7-9).
The aim of this study was to assess the accuracy of imaging techniques (MDTC and MRI) in HCC pretransplantation staging,
with histopathologic evaluation of the explanted liver as the reference standard.
The secondary objective was to identify pathologic and imaging predictive factors for HCC recurrence after LT.