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Background & Aims: In patients with cirrhosis, hepatocellular carcinoma (HCC) is detected by ultrasound (US), computed tomography (CT), or magnetic resonance imaging (MRI); US is recommended for screening and surveillance. We performed a retrospective analysis of the abilities of these cross-sectional imaging modalities to detect HCC. Methods: We analyzed data from 638 consecutive adult patients with cirrhosis who received liver transplants within 6 months of imaging at a tertiary care institution. Imaging reports and serum alpha-fetoprotein levels were compared with results from pathology analysis of explants as the reference standard. Sensitivities of US, CT, and MRI were calculated overall and in defined size categories. False-positive imaging results and patient-based specificities were evaluated. Results: Of the 638 patients, 225 (35%) had HCC, confirmed by pathology analysis of liver explants. In 23 cases, the lesions were infiltrative or extensively multifocal. In the remaining 202 explants (337 numerable, discrete nodules), respective lesion-based sensitivities of US, CT, and MRI were 46%, 65%, and 72% overall and 21%, 40%, and 47% for small (<2 cm) HCC. The sensitivity of US increased with the availability of CT or MRI data (P = .049); sensitivity values were 62% and 85% for lesions 2–4 and ≥4 cm, respectively. Patient-based specificities of US, CT, and MRI were 96%, 96%, and 87%, respectively. Conclusions: US, CT, and MRI did not detect small HCC lesions with high levels of sensitivity, although CT and MRI provide substantial improvements over unenhanced US in patients with cirrhosis who received liver transplants. [ABSTRACT FROM AUTHOR]

Imaging studies play a crucial role in the diagnosis and management of patients with pancreatic adenocarcinoma. Computed tomography (CT) is the most widely available and best-validated modality for imaging patients with pancreatic adenocarcinoma. To maximize the diagnostic efficacy of CT, use of a pancreas protocol is mandatory. The sensitivity of CT for diagnosis of pancreatic adenocarcinoma (89%–97%) and its positive predictive value for predicting unresectability (89%–100%) are high. The positive predictive value of CT for predicting resectability (45%–79%) is low because the diagnostic criteria for diagnosing vascular invasion by tumor favors specificity over sensitivity to avoid denying surgery to patients with potentially resectable tumor. Furthermore, the sensitivity of CT for small hepatic and peritoneal metastases is limited. Magnetic resonance imaging has not been shown to perform better than CT for the diagnosis and staging of pancreatic adenocarcinoma, but can be helpful as an adjunct to CT, particularly for evaluation of small hepatic lesions that cannot be fully characterized by CT. Ultrasound is often the first study obtained in patients with obstructive jaundice or unexplained abdominal pain, but its utility for diagnosis and staging of patients with pancreatic adenocarcinoma is limited. Positron emission tomography/CT combines the functional information provided by positron emission tomography with the anatomic information provided by CT and is a promising modality for imaging of patients with pancreatic adenocarcinoma, but its utility has not been established. Endoscopic ultrasound is generally considered superior to CT for the diagnosis and local staging of pancreatic cancer, but is limited by availability and inability to assess for distant metastases. [Copyright &y& Elsevier]