Diagnosis and staging of hepatocellular carcinoma: comparison of CT and sonography in 36 liver transplantation patients.

Radiologic studies are important in the detection of hepatocellular carcinoma and the selection of patients for partial liver resection, liver transplantation, or palliation. We retrospectively studied 36 patients with hepatocellular carcinoma who were examined with both CT and sonography before undergoing hepatic transplantation. Pathologic findings of the entire resected liver were correlated with results of imaging studies before transplantation. Parenchymal lesions were shown by sonography in 29 cases (81%) and by CT in 34 cases (94%). Although CT was more sensitive than sonography was, both CT and sonography frequently failed to depict reliably the size of tumor or the exact number of tumor nodules as determined pathologically. Pathologic findings showed vascular invasion in 19 cases (53%), whereas CT showed invasion in 11 cases (31%) and sonography showed it in only six (17%). Nodal metastasis to the porta hepatis was found in four patients; CT correctly showed two cases (three false-positive) and sonography correctly showed one case. Intrahepatic ductal dilatation was seen in eight patients on CT but was not identified on sonography. We conclude that CT is more accurate for identifying and staging hepatocellular carcinoma, but both CT and sonography frequently fail to depict the extent (size and number of lesions) of disease, especially when underlying cirrhosis is present.