Detection of Focal Hepatic Lesions in Patients with Liver Cirrhosis Undergoing Transplant Evaluation

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Purpose: Ultrasound imaging (U/S) and magnetic resonance imaging (MRI) are used extensively in the clinical practice to detect focal lesions in the liver. The purpose of this study is to determine the sensitivity of MRI compared to U/S in detecting focal hepatic lesions in patients with end stage liver disease undergoing liver transplant evaluation. Methods: This was a retrospective study of patients with decompensated cirrhosis undergoing liver transplant evaluation. As part of the routine liver transplant evaluation at our institution, patients undergo imaging of the liver with both U/S and MRI. Identified lesions are then managed as appropriate based on clinical relevance. Patients were selected who had imaging with both U/S and MRI within the same month and identified lesions were evaluated for clinical significance requiring further management. Results: From March, 2003 to May, 2005, a total of 268 patients underwent liver transplant evaluation. A total of 147 patients (93 males; 54 females) met the inclusion criteria for the study including imaging using both U/S and MRI with one month time period. There were 34 (23%) patients with focal lesions identified on imaging. Of these, 16 (47%) patients were identified by both U/S and MRI, 17 (50%) were identified by only MRI, and 1 (3%) was identified by only U/S (McNemar's p < .0002). Sensitivity was 50% and 97% with a NPV of 87% and 99% on U/S and MRI, respectively. Two lesions identified as cysts not requiring further follow-up. The other 32 (94%) lesions were all clinically significant that resulted in a change in management of the patient. Conclusions: Prevalence of focal liver lesions in patients with end stage disease was 23% with 94% of these having clinical significance requiring a change in management. Imaging with MRI was significantly superior to U/S in identification of focal liver lesions including clinically relevant lesions. In this population with end stage liver disease undergoing liver transplant evaluation, recognizing potentially malignant liver lesions is critical in the management of these patients. Further studies to correlate lesions identified on imaging with pathology are needed.