Limitations of current preoperative liver imaging techniques for intrahepatic metastatic nodules of hepatocellular carcinoma.

To determine the limitations of the latest techniques in preoperative liver imaging for hepatocellular carcinoma, 20 patients with histologically proven intrahepatic metastatic tumors were studied. In 32 masses, we were able to assess the relationship between these intrahepatic metastatic tumors and the findings of preoperative imaging individually. Six intrahepatic metastatic tumors not exceeding 5 mm in diameter were missed in all the imaging examinations. The detection rate was 60% in 13 intrahepatic metastatic tumors of 5 to 10 mm, 77% in 10 intrahepatic metastatic tumors of 10 to 20 mm and 100% in 3 intrahepatic metastatic tumors exceeding 20 mm. In total, computed tomographic imaging during arterial portography demonstrated the highest rate of detection (40%) of all the studies performed. Magnetic resonance imaging, which was recently introduced, was rather disappointing (31%) in this series. In two patients, intrahepatic metastatic tumors were only histologically confirmed. Our study suggests a low rate of detection of intrahepatic metastatic tumors with current preoperative imaging modalities. For improvement of prognosis after hepatectomy for hepatocellular carcinoma adjuvant therapy and extended hepatectomy seem necessary if the functional capacity of the remaining liver permits.