Triple-phase Multidetector Computed Tomography: An Evaluation of Hepatic Space Occupying Lesion in Cirrhotic Patients

Hepatocellular carcinoma (HCC) is a common tumor with an incidence of 1 – 6 % among cirrhotic patients. Dysplastic nodule often occurs within regenerative cirrhotic nodules. They can show low or high grade dysplasia. MRI best differentiates this iso or hypo intense lesion from hyper intense HCC. The current study was designed to assess the usefulness of Triple-phase multiphasic multidetector computed tomography (MDCT) in evaluation of hepatic space occupying lesion in cirrhotic patients. This cross sectional study was carried out in the Radiology and Imaging department in collaboration with Hepatology and Hepatobiliary surgery department, of Bangabandhu Sheikh Mujib Medical University, Dhaka during July 2014 to June 2016. A total of 62 cirrhotic patients with hepatic space occupying lesion were included in this study. MDCT was done in all these patients and they were followed-up from the admission up to post operative tissue diagnosis of hepatic space occupying lesion in respective pathology departments to assess the histopathological correlation. Patients with suspected hepatic space occupying lesion diagnosed by clinical and ultrasonography and having high serum α-fetoprotein level were enrolled. The mean age was 50.0±13.6 years with ranged from 25 to 79 years. Male female ratio was 2.3:1. In MDCT, a total of 54 malignant cases were to be found, out of which 49(79.0%) patients had HCC, 4(6.5%) had metastases and 1(1.6%) had dysplastic nodule. In benign tumor group, 6(9.7%) patients had cirrrhotic nodule, 1(1.6%) had hepatic adenoma and 1(1.6%) had haemangioma. In histopahology, a total 53 malignant cases were found, out of them 48(77.5%) patients had HCC, 3(4.8%) had metastases and 2(3.2%) had dysplastic nodule. Triphasic MDCT in diagnosis of hepatic space occupying lesion in cirrhotic patients revealed a sensitivity of 98.1%, specificity of 77.8%, accuracy 95.2%, positive predictive values 96.3% and negative predictive values 87.5%. While the same diagnostic tool showed a sensitivity 95.8%, specificity 78.6%, accuracy 91.9%, positive predictive values 93.9% and negative predictive values 84.6% in identification of HCC. In evaluation of metastasis MDCT had a sensitivity of 100.0%, specificity 98.3%, accuracy 98.4%, positive predictive values 75.0% and negative predictive values 100.0%. In evaluation of dysplastic nodule MDCT had sensitivity 50.0%, specificity 100.0%, accuracy 98.4%, positive predictive values 100.0% and negative predictive values 98.4%. So, MDCT can be an ideal diagnostic tool for detecting as well as characterizing the hepaticspace occupying lesion (SOLs) in cirrhotic patients.


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