CT portography and post-lipiodol CT in the preinterventional work-up of primary and secondary liver tumors. A single center experience.
BACKGROUND/AIMS: The evaluation of the clinical use of CT portography (CTp) and post-lipiodol CT (CT post-lip) in terms of therapeutic implications in patients with liver malignancies, particularly hepatocellular carcinoma (HCC). METHODOLOGY: We prospectively evaluated 130 patients with CTp and CT post-lip: 109 with HCC and underlying cirrhosis (group I) and 21 with liver metastases considered for surgical resection (group II). All patients also underwent hepatic angiography (hA). Mean lesion size was 4.6 cm and 2.2 cm for group I and II respectively. Previous contrast-enhanced CT studies were available for comparison. RESULTS: Diagnostic CTp examinations resulted in only 84.4% of group I due to enhancement in homogeneities and in all patients from group II. In comparison with the referral CT, additional lesions were seen in 83.6% of the HCC group and in 66.6% of the metastatic group that implicated treatment alterations in 15.21% and in 23.8% of them, respectively. Hepatic angiography revealed hypervascularity in 91.3% of HCC lesions and in 33.3% of metastatic ones. CT post-lip images suitable for evaluation resulted in 104/130 patients (80%). At CT post-lip false negative results were observed in 33.73% patients with HCC and in 30.95% patients with liver metastases. Selective lipiodol retention was seen in only 50% of the biopsy proved satellites. CONCLUSIONS: CTp reveals additional lesions that have therapeutic implications in at least 15% of HCC patients and in 20% of patients with metastatic disease, and should be routinely included in the preinterventional work-up particularly for cases in which intraarterial or percutaneous treatment is scheduled. By contrast, CT post-lip seems to be of limited value unless it is evaluated in combination with CTp and angiography.