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Gastrointestinal Imaging |
1 From the Mallinckrodt Institute of Radiology (S.A.T., C.C.H., F.D., B.A.S., J.P.H., J.J.B., E.G.M., W.D.M., D.M.B.), Departments of Internal Medicine (M.G.P.) and Pathology (J.H.R.), and Siteman Cancer Center (S.A.T., C.C.H., F.D., B.A.S., J.P.H., J.J.B., E.G.M., W.D.M., D.M.B., J.H.R.), Washington University School of Medicine, 510 S Kingshighway Blvd, St Louis, MO 63110. Received December 4, 2001; revision requested February 18, 2002; revision received April 8; accepted May 23. Address correspondence to S.A.T. (e-mail: teefeys@mir.wustl.edu).
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-by-patient 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.
© RSNA, 2003
Index terms: Computed tomography (CT), comparative studies, 761.12114 • Liver neoplasms, 761.323 • Magnetic resonance (MR), comparative studies, 761.121411, 761.121412, 761.121416, 761.12143 • Positron emission tomography (PET), comparative studies, 761.12163 • Ultrasound (US), comparative studies, 761.12981, 761.12983
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