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. 1997 Sep;41(3):404–407. doi: 10.1136/gut.41.3.404

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

J Saada 1, S Bhattacharya 1, A Dhillon 1, R Dick 1, A Burroughs 1, K Rolles 1, B Davidson 1
PMCID: PMC1891483  PMID: 9378400

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. 



Keywords: liver cirrhosis; transplantation; hepatocellular carcinoma; iodised oil; computed tomography

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Figure 1 .

Figure 1

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


Figure 2 .

Figure 2

Figure 2

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: (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. 


Selected References

These references are in PubMed. This may not be the complete list of references from this article.

  1. Arnold M. M., Wallace A. C., Kreel L., Li M. K. Demonstration of Lipiodol in paraffin sections using a modified silver impregnation technique. Am J Clin Pathol. 1990 Nov;94(5):585–589. doi: 10.1093/ajcp/94.5.585. [DOI] [PubMed] [Google Scholar]
  2. Bhattacharya S., Davidson B., Dhillon A. P. Blood supply of early hepatocellular carcinoma. Semin Liver Dis. 1995 Nov;15(4):390–401. doi: 10.1055/s-2007-1007289. [DOI] [PubMed] [Google Scholar]
  3. Choi B. I., Park J. H., Kim B. H., Kim S. H., Han M. C., Kim C. W. Small hepatocellular carcinoma: detection with sonography, computed tomography (CT), angiography and Lipiodol-CT. Br J Radiol. 1989 Oct;62(742):897–903. doi: 10.1259/0007-1285-62-742-897. [DOI] [PubMed] [Google Scholar]
  4. Demetris A. J., Jaffe R., Starzl T. E. A review of adult and pediatric post-transplant liver pathology. Pathol Annu. 1987;22(Pt 2):347–386. [PubMed] [Google Scholar]
  5. Ferrell L., Wright T., Lake J., Roberts J., Ascher N. Incidence and diagnostic features of macroregenerative nodules vs. small hepatocellular carcinoma in cirrhotic livers. Hepatology. 1992 Dec;16(6):1372–1381. doi: 10.1002/hep.1840160612. [DOI] [PubMed] [Google Scholar]
  6. Ngan H. Lipiodol computerized tomography: how sensitive and specific is the technique in the diagnosis of hepatocellular carcinoma? Br J Radiol. 1990 Oct;63(754):771–775. doi: 10.1259/0007-1285-63-754-771. [DOI] [PubMed] [Google Scholar]
  7. Okuda K., Peters R. L., Simson I. W. Gross anatomic features of hepatocellular carcinoma from three disparate geographic areas. Proposal of new classification. Cancer. 1984 Nov 15;54(10):2165–2173. doi: 10.1002/1097-0142(19841115)54:10<2165::aid-cncr2820541017>3.0.co;2-7. [DOI] [PubMed] [Google Scholar]
  8. Takayasu K., Moriyama N., Muramatsu Y., Makuuchi M., Hasegawa H., Okazaki N., Hirohashi S. The diagnosis of small hepatocellular carcinomas: efficacy of various imaging procedures in 100 patients. AJR Am J Roentgenol. 1990 Jul;155(1):49–54. doi: 10.2214/ajr.155.1.1693808. [DOI] [PubMed] [Google Scholar]
  9. Taourel P. G., Pageaux G. P., Coste V., Fabre J. M., Pradel J. A., Ramos J., Larrey D., Domergue J., Michel H., Bruel J. M. Small hepatocellular carcinoma in patients undergoing liver transplantation: detection with CT after injection of iodized oil. Radiology. 1995 Nov;197(2):377–380. doi: 10.1148/radiology.197.2.7480680. [DOI] [PubMed] [Google Scholar]
  10. Yamamoto M., Iimuro Y., Mogaki M., Kachi K., Fujii H., Matsumoto Y. Prediction of recurrence after HCC resection. Faint oily deposits on preoperative Lipiodol-CT of remnant liver tissue. Acta Radiol. 1994 Jul;35(4):329–334. [PubMed] [Google Scholar]
  11. Yokoyama I., Sheahan D. G., Carr B., Kakizoe S., Selby R., Tzakis A. G., Todo S., Iwatsuki S., Starzl T. E. Clinicopathologic factors affecting patient survival and tumor recurrence after orthotopic liver transplantation for hepatocellular carcinoma. Transplant Proc. 1991 Aug;23(4):2194–2196. [PubMed] [Google Scholar]
  12. Yoshimatsu S., Inoue Y., Ibukuro K., Suzuki S. Hypovascular hepatocellular carcinoma undetected at angiography and CT with iodized oil. Radiology. 1989 May;171(2):343–347. doi: 10.1148/radiology.171.2.2539607. [DOI] [PubMed] [Google Scholar]

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