TY - JOUR
T1 - Detection of primary hepatic malignancy in liver transplant candidates
T2 - Prospective comparison of CT, MR imaging, US, and PET
AU - Teefey, Sharlene A.
AU - Hildeboldt, Charles C.
AU - Dehdashti, Farrokh
AU - Siegel, Barry A.
AU - Peters, Marion G.
AU - Heiken, Jay P.
AU - Brown, Jeffrey J.
AU - McFarland, Elizabeth G.
AU - Middleton, William D.
AU - Balfe, Dennis M.
AU - Ritter, Jon H.
PY - 2003/2/1
Y1 - 2003/2/1
N2 - PURPOSE: To determine and compare the diagnostic performance of computed tomography (CT), magnetic resonance (MR) imaging, ultrasonography (US), and positron emission tomography (PET) in the detection of hepatocellular carcinoma (HCC) or cholangiocarcinoma in liver transplant candidates and to determine interobserver variability between the readers. MATERIALS AND METHODS: Twenty-five patients were examined prospectively with CT, MR imaging, US, and PET. Each test result was interpreted independently by two radiologists. Explanted liver specimens were examined histologically to determine presence and type of lesion. Results were analyzed on a patient-bypatient basis with marginal homogeneity and effect likelihood ratio tests. RESULTS: HCC was diagnosed in nine patients. US diagnostic performance was superior to that of CT and MR imaging on a patient-by-patient basis. Sensitivities were higher for US (0.89 for both US readers) than they were for CT (0.67 and 0.56 for readers 1 and 2, respectively), MR imaging (0.56 and 0.50 for readers 1 and 2, respectively), and PET (0 for both readers). None of the differences (within test) between readers were significant (P ≥ .32). Ratings by US and MR observers and one CT observer were significantly associated with truth (P ≤ .04). One or more imaging tests depicted 68 lesions. Histologic analysis revealed 18 HCC nodules; of these, 13 were correctly identified at CT, 14 at MR imaging, 13 at US, and none at PET. There were nine false-positive diagnoses of HCC with CT, five with MR imaging, and nine with US. CONCLUSION: Although US had the best diagnostic performance in depicting HCC on a patient-by-patient basis and was substantially better than were MR imaging and CT (which had nearly equivalent diagnostic performances), CT, US, and MR imaging performed similarly on a lesion-by-lesion basis. Small tumor nodules were the most common cause of missed HCCs with all tests. PET did not depict any HCCs.
AB - PURPOSE: To determine and compare the diagnostic performance of computed tomography (CT), magnetic resonance (MR) imaging, ultrasonography (US), and positron emission tomography (PET) in the detection of hepatocellular carcinoma (HCC) or cholangiocarcinoma in liver transplant candidates and to determine interobserver variability between the readers. MATERIALS AND METHODS: Twenty-five patients were examined prospectively with CT, MR imaging, US, and PET. Each test result was interpreted independently by two radiologists. Explanted liver specimens were examined histologically to determine presence and type of lesion. Results were analyzed on a patient-bypatient basis with marginal homogeneity and effect likelihood ratio tests. RESULTS: HCC was diagnosed in nine patients. US diagnostic performance was superior to that of CT and MR imaging on a patient-by-patient basis. Sensitivities were higher for US (0.89 for both US readers) than they were for CT (0.67 and 0.56 for readers 1 and 2, respectively), MR imaging (0.56 and 0.50 for readers 1 and 2, respectively), and PET (0 for both readers). None of the differences (within test) between readers were significant (P ≥ .32). Ratings by US and MR observers and one CT observer were significantly associated with truth (P ≤ .04). One or more imaging tests depicted 68 lesions. Histologic analysis revealed 18 HCC nodules; of these, 13 were correctly identified at CT, 14 at MR imaging, 13 at US, and none at PET. There were nine false-positive diagnoses of HCC with CT, five with MR imaging, and nine with US. CONCLUSION: Although US had the best diagnostic performance in depicting HCC on a patient-by-patient basis and was substantially better than were MR imaging and CT (which had nearly equivalent diagnostic performances), CT, US, and MR imaging performed similarly on a lesion-by-lesion basis. Small tumor nodules were the most common cause of missed HCCs with all tests. PET did not depict any HCCs.
KW - Comparative studies
KW - Computed tomography (CT)
KW - Liver neoplasms
KW - Magnetic resonance (MR)
KW - Positron emission tomography (PET)
KW - Ultrasound (US)
UR - http://www.scopus.com/inward/record.url?scp=0037293402&partnerID=8YFLogxK
U2 - 10.1148/radiol.2262011980
DO - 10.1148/radiol.2262011980
M3 - Article
C2 - 12563151
AN - SCOPUS:0037293402
SN - 0033-8419
VL - 226
SP - 533
EP - 542
JO - Radiology
JF - Radiology
IS - 2
ER -