Accuracy of Computed Tomography in the Assessment of Milan Criteria in Liver Transplantation for Hepatocellular Carcinoma

Background. Despite worldwide debate on optimal selection of patients with hepatocellular carcinoma (HCC) for liver transplantation, the Milan criteria remain the benchmark for comparisons. Moreover, morphologic tumor features are universally considered important in pretransplant patient evaluation. The aim of this study was to establish the diagnostic accuracy of multiphasic computed tomography (CT) in assessing HCC burden before liver transplantation with special reference to Milan criteria fulfillment. Methods. This retrospective study was based on a data from 27 HCC patients after liver transplantation with available CT performed within 30 days pretransplant. CT results were compared with explant pathology with respect to Milan criteria fulfillment, tumor number, and diameter of the largest tumor. Results. Out of 19 patients within the Milan criteria on CT, 3 fell beyond the criteria on explant pathology with a gross underestimation rate of 15.8%. Out of 8 patients beyond the Milan criteria on CT, 3 were within the criteria on explant pathology with a gross overestimation rate of 37.5%. Regarding tumor number, CT was accurate only in 14 patients (51.9%), while overestimation and underestimation occurred in 5 (18.5%) and 8 (29.6%) patients, respectively. Overestimation and underestimation of largest tumor size by at least 1 cm occurred in 4 (14.8%) and 7 (25.9%) patients, respectively. Discussion. Multiphasic CT is associated with a remarkable risk of both under- and overestimation of HCC burden before transplantation. Transplant eligibility should not be solely based on CT results.