Usefulness of Combined CTAP and CTHA as a Preoperative Study of Hepatocellular Carcinoma

Lee, Suk Ho; Lee, Joon Hyoek; Koh, Kwang Cheol; Paik, Seung Woon; Lee, Jong Kyun; Lee, Kyu Taek; Kang, In Koo; Oh, Sung Yun; Rhee, Poong Lyul; Kim, Jae Jun; Rhee, Jong Chul

Abstract

BACKGROUND/AIMS
Combined computed tomography during arterial portography(CfAP) and computed tomography during hepatic arteriography(CBiA) are more sensitive methods compared to conventional spiral CT in detecting small hepatocellular carcinoma. However, there are few data available on the influence of combined CTAP and CTHA on decision making for treatment of hepatocellular carcinoma. We aimed to evaluate the usefulness of CTAP and CfHA as a preoperative study of hepatocellular carcinoma for surgical treatment.
METHODS
Eighty-two patients with histologically proven hepatocellular carcinoma who were considered to be surgical candidates on spiral CT and angiography were included. CfAP and CTHA were performed as the routine protocol. The findings of CTAP and CTHA were analyzed and compared to conventianal spiral Cl and angiography. ReESULTS: 1) 105 nodules were found on spiral Cf plus angiography, whereas, 138 nodules found on combined CIAP and CTHA: 33 additional nodules were found in 23 cases(28%). 2) The treatment plan changed from surgery to nonsurgical treatment in 10(12%) cases: 9 cases(10%) with bilobar involvement, and 1 case (1%) with more than three nodules. 3) The larger the tumor nodules on the spiral CT, the more additional tumor nodules were found on CTAP and CTHA: combined CTAP and CTHA were able to find more nodules in 21% of tumor < 3cm, 27% of tumor with 3 - 10cm, and 71% of tumor >10cm on spiral CI' (p=0.03).
CONCLUSION
Compared to spiral CT plus angiography, CI'AP and CfHA may be useful in avoiding unnecessary operation of hepatocellular carcinoma, especially in large tumors.