Hepatocellular Carcinoma: Are Combined CT during Arterial Portography and CT Hepatic Arteriography in Addition to Triple-Phase Helical CT All Necessary for Preoperative Evaluation?

Abstract

To determine whether the combination of CT during arterial portography (CTAP) and CT hepatic arteriography (CTHA) provides an added benefit to triple-phase helical CT (THCT) alone in the preoperative evaluation of hepatocellular carcinoma (HCC). Fifty-two consecutive patients with pathologically proved HCC underwent THCT (hepatic arterial, portal venous, and delayed phases) and combined CTAP and CTHA. Two radiologists reviewed the images in three sessions: first the THCT images alone, then with the CTAP images, and finally all three sets of images. There were 73 pathologically confirmed HCCs. Among 72 lesions considered as HCC at THCT, 69 were proved to be HCCs. Of the additional 37 nodules interpreted as HCC at CTAP, only one was confirmed as such. Among the additional 20 lesions presumed to be HCC at combined CTAP and CTHA, only two were proved to be HCCs. The sensitivity was 94% (69 of 73 lesions) at THCT, 96% (70 of 73) with additional CTAP, and 97% (71 of 73) with all three modalities. The positive predictive value was 96% (69 of 72) at THCT, 65% (70 of 107) with additional CTAP, and 80% (71 of 89) with all three modalities. The use of CTAP and CTHA, in addition to being invasive and costly, resulted in an unacceptably high false-positive rate without a substantial increase in sensitivity. Therefore, CTAP and CTHA are not recommended for preoperative evaluation of HCC; THCT alone is preferred.