AIM:To elucidate causes for false negative magnetic resonance imaging(MRI)exams by identifying imaging characteristics that predict viable hepatocellular carcinoma(HCC)in lesions previously treated with locoregional t...AIM:To elucidate causes for false negative magnetic resonance imaging(MRI)exams by identifying imaging characteristics that predict viable hepatocellular carcinoma(HCC)in lesions previously treated with locoregional therapy when obvious findings of recurrence are absent.METHODS:This retrospective institutional review board-approved and Health Insurance Portability and Accountability Act-compliant study included patients who underwent liver transplantation at our center between 1/1/2000 and 12/31/2012 after being treated for HCC with locoregional therapy.All selected patients had a contrast-enhanced MRI after locoregional therapy within 90 d of transplant that was prospectively interpreted as without evidence of residual or recurrenttumor.Retrospectively,2 radiologists,blinded to clinica and pathological data,independently reviewed the pre transplant MRIs for 7 imaging features.Liver explan histopathology provided the reference standard,with clinically significant tumor defined as viable tumor≥1.0cm in maximum dimension.Fisher’s exact test was firs performed to identify significant imaging features.RESULTS:Inclusion criteria selected for 42 patients with 65 treated lesions.Fourteen of 42 patients(33%and 16 of 65 treated lesions(25%)had clinically significant viable tumor on explant histology.None o the 7 imaging findings examined could reliably and reproducibly determine which treated lesion had viable tumor when the exam had been prospectively read as without evidence of viable HCC.CONCLUSION:After locoregional therapy some treated lesions that do not demonstrate any MRI evidence o HCC will contain viable tumor.As such even patients with a negative MRI following treatment should receive regular short-term imaging surveillance because some have occult viable tumor.The possibility of occult tumo should be a consideration when contemplating any action which might delay liver transplant.展开更多
文摘AIM:To elucidate causes for false negative magnetic resonance imaging(MRI)exams by identifying imaging characteristics that predict viable hepatocellular carcinoma(HCC)in lesions previously treated with locoregional therapy when obvious findings of recurrence are absent.METHODS:This retrospective institutional review board-approved and Health Insurance Portability and Accountability Act-compliant study included patients who underwent liver transplantation at our center between 1/1/2000 and 12/31/2012 after being treated for HCC with locoregional therapy.All selected patients had a contrast-enhanced MRI after locoregional therapy within 90 d of transplant that was prospectively interpreted as without evidence of residual or recurrenttumor.Retrospectively,2 radiologists,blinded to clinica and pathological data,independently reviewed the pre transplant MRIs for 7 imaging features.Liver explan histopathology provided the reference standard,with clinically significant tumor defined as viable tumor≥1.0cm in maximum dimension.Fisher’s exact test was firs performed to identify significant imaging features.RESULTS:Inclusion criteria selected for 42 patients with 65 treated lesions.Fourteen of 42 patients(33%and 16 of 65 treated lesions(25%)had clinically significant viable tumor on explant histology.None o the 7 imaging findings examined could reliably and reproducibly determine which treated lesion had viable tumor when the exam had been prospectively read as without evidence of viable HCC.CONCLUSION:After locoregional therapy some treated lesions that do not demonstrate any MRI evidence o HCC will contain viable tumor.As such even patients with a negative MRI following treatment should receive regular short-term imaging surveillance because some have occult viable tumor.The possibility of occult tumo should be a consideration when contemplating any action which might delay liver transplant.
