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Multidetector Computed Tomography Triphasic Evaluation of the Liver Before Transplantation: Importance of Equilibrium Phase Washout and Morphology for Characterizing Hypervascular Lesions

Liu, Yueyi I. MD, PhD; Kamaya, Aya MD; Jeffrey, R. Brooke MD; Shin, Lewis K. MD

Journal of Computer Assisted Tomography: March/April 2012 - Volume 36 - Issue 2 - p 213–219
doi: 10.1097/RCT.0b013e318247c8f0
Abdominal Imaging

Objective We aim to identify the sensitivity and positive predictive value (PPV) of arterial phase imaging in detecting hepatocellular carcinoma (HCC) and determine the added value of portal venous and equilibrium phase imaging and lesion morphology characterization.

Methods We reviewed all patients who underwent liver transplantation at our institution that had a triphasic multidetector computed tomography examination within 6 months of transplantation. Forty-seven hypervascular lesions were identified in 24 patients. Imaging findings were correlated with explant pathologic correlation.

Results Hypervascularity in the arterial phase resulted in sensitivity of 87.5% and PPV of 29.8%. The presence of washout in the equilibrium phase increased the PPV to 92.9% with a slight decrease in sensitivity (81.3%). The negative predictive value of hypervascular lesions without washout in the equilibrium phase was 97.1%. There was significant correlation between larger lesions and HCC and between round lesions and HCC.

Conclusions The presence of washout in the equilibrium phase is a better indicator of malignancy.

From the Department of Radiology, Stanford University School of Medicine, Stanford, CA.

Received for publication July 29, 2011; accepted December 21, 2011.

Reprints: Lewis K. Shin, MD, Department of Radiology, Stanford University School of Medicine, 300 Pasteur Dr H1307, Stanford, CA 94305 (e-mail:

Dr Kamaya is currently receiving grants from the Society of Gastrointestinal Radiologists and Society of Uroradiology. For the remaining authors, none were declared.

© 2012 Lippincott Williams & Wilkins, Inc.