Diagnostic value and tolerance of Lipiodol-computed tomography for the detection of small hepatocellular carcinoma: correlation with pathologic examination of explanted livers

Background/Aims: This study aimed to assess the tolerance and the real sensitivity of Lipiodol-computed tomography in the detection of small hepatocellular carcinoma by comparison with pathological examination of the explanted livers. Methods: Seventy-two patients with cirrhosis (Child A=8, B=36, C=28) awaiting orthotopic liver transplantation underwent Lipiodol-computed tomography to determine the presence, number and location of possible hepatocellular carcinoma nodules, Before liver transplantation six patients had a presumed single hepatocellular carcinoma diagnosed by biopsy Liver transplantation was performed a mean of 6 months after Lipiodol-computed tomography, Explanted livers were sectioned at 0.8- to 1-cm intervals, Lipiodol-computed tomography staging and pathologic findings were compared, Results: Pathologic studies showed 24 hepatocellular carcinoma nodules (diameter, 2-42 mm) not diagnosed before liver transplantation in 14 of the 72 livers, Lipiodol-computed tomography detected 6 of these 24 nodules, but none of the daughter lesions (n=9) in the sis patients with a presumed single hepatocellular carcinoma, Lesion-by-lesion analysis revealed a sensitivity of 37%, Lipiodol-computed tomography falsely detected three additional nodules not confirmed by pathologic examination (1 haemangioma, 2 nondysplastic regenerating nodules), One Child C patient developed variceal bleeding within 2 days after injection of Lipiodol, Conclusions: Tolerance of this procedure was satisfactory, even in Child C patients, Lipiodol-computed tomography has a low sensitivity in the detection of small hapatocellular carcinoma, These results must be considered when liver resection or liver transplantation is proposed for the treatment of hepatocellular carcinoma.