Veltri A, Robba T, Anselmetti G C, Martina M C, Regge D, Grosso M, Fava C
Dipartimento di Discipline Medico-Chirurgiche dell'Università, Torino.
Radiol Med. 1998 Jul-Aug;96(1-2):81-6.
To assess the diagnostic accuracy and predictive value of Lipiodol CT for hepatocellular carcinoma (HCC) before liver transplantation (OLT).
Seventy-eight cirrhotic patients awaiting OLT underwent Lipiodol CT to demonstrate the presence and extent of possible HCC. Radiologically, focal uptake areas with dense, homogeneous or "mosaic" iodized oil uptake were considered to be neoplastic nodules. All patients underwent OLT within 4 months of Lipiodol CT. Pathologic examination of the explanted livers was performed using the standard technique and, if necessary, with additional slices. Pathologic findings were compared with radiologic results to calculate the diagnostic accuracy and predictive value of Lipiodol CT in relation to both patients and lesions.
Lipiodol CT depicted 61 focal areas of iodized oil uptake in 48 patients; pathologic examinations detected 57 HCC lesions in 42 patients (diameter .8 cm, mean 2.2 cm); agreement with radiologic diagnosis was found in 35 patients only. Patient by patient, Lipiodol CT had 83.3% sensitivity, 63.8% specificity, 74.3% diagnostic accuracy, 72.9% positive predictive value (PPV), and 76.6% negative predictive value. Lesion by lesion, Lipiodol CT showed overall sensitivity and PPV of 75.4-70.5%, 74-69.8% for "small" HCCs (diameter < or = 3 cm), and 72.9-71.1% for nodules < or = 2 cm in size. Eighteen uptake areas in 13 patients were diagnosed as HCC by Lipiodol CT but the finding was not confirmed at histology: 4 were hemangiomas and 14 corresponded to cirrhotic tissue without neoplastic foci.
Our study, as the few others comparing radiologic results and pathologic findings of whole explanted liver, demonstrates that Lipiodol CT has relatively low diagnostic accuracy; particularly, specificity and PPV were limited by possible false positives, with HCC overstaging and mistakes in the indications/contraindications for OLT.
评估碘油CT对肝移植（OLT）前肝细胞癌（HCC）的诊断准确性及预测价值。
78例等待OLT的肝硬化患者接受碘油CT检查，以显示可能存在的HCC及其范围。在放射学上，碘油摄取浓密、均匀或呈“镶嵌”状的局灶性摄取区域被视为肿瘤结节。所有患者在碘油CT检查后4个月内接受OLT。对切除的肝脏进行标准病理检查，必要时增加切片。将病理结果与放射学结果进行比较，以计算碘油CT对患者和病变的诊断准确性及预测价值。
碘油CT显示48例患者有61个碘油摄取局灶区；病理检查发现42例患者有57个HCC病灶（直径.8 cm，平均2.2 cm）；仅35例患者的放射学诊断与病理诊断相符。逐例分析，碘油CT的敏感性为83.3%，特异性为63.8%，诊断准确性为74.3%，阳性预测值（PPV）为72.9%，阴性预测值为76.6%。逐个病灶分析，碘油CT对“小”HCC（直径≤3 cm）的总体敏感性和PPV为75.4 - 70.5%、74 - 69.8%，对直径≤2 cm的结节为72.9 - 71.1%。13例患者的18个摄取区经碘油CT诊断为HCC，但组织学检查未证实：4个为血管瘤，14个对应无肿瘤灶的肝硬化组织。
我们的研究是少数比较整个切除肝脏的放射学结果和病理结果的研究之一，表明碘油CT的诊断准确性相对较低；特别是，特异性和PPV受到可能的假阳性限制，会导致HCC分期过高以及OLT适应证/禁忌证判断错误。
