Imaging prediction of residual hepatocellular carcinoma after locoregional therapy in patients undergoing liver transplantation or partial hepatectomy

Purpose: Locoregional therapies for hepatocellular carcinoma (HCC) offer alternatives for patients unable to undergo resection or awaiting transplant. We sought to evaluate the prevalence and interobserver agreement of imaging features suggestive of viable tumor at posttherapy CT/MRI and to determine a size threshold for tumor detection. Methods: Patients having undergone liver transplant or hepatectomy between 2012 and 2014 with presurgical embolization or ablation of HCC were identified. Imaging was retrospectively reviewed, and enhancement characteristics of each lesion were noted by two radiologists. Original pathology slides were reviewed, and the size of nodular viable tumor was noted, if present. Cohen’s kappa was used to evaluate interobserver agreement. Results: 87 patients with 129 HCCs were reviewed retrospectively following IRB approval. 50% (65/129) of lesions showed viable tumor at pathology. 86 lesions (67%) were imaged with CT and 43 (33%) with MR. Of viable lesions, 25 (38%) showed nodular arterial enhancement and 18 (28%) demonstrated washout. One lesion had capsule appearance. Sensitivity/specificity for nodular enhancement, washout, and capsule were 0.38/0.83, 0.28/0.89, and 0.02/1.00, respectively. Overall detection rate was 41% of <1 cm, 54% of 1–2 cm, and 57% of >2 cm viable lesions. Conclusions: Nodular arterial enhancement was most frequently observed, followed by washout. Both showed moderate interobserver agreement. Sensitivity of any imaging feature was less than 50%, though findings were specific for viable disease.