Background: Accurate preoperative imaging is an important aspect of patient evaluation before liver transplantation for hepatocellular carcinoma (HCC) because the size and number of tumors are indicators of posttransplant prognosis. This study aimed to evaluate the preoperative detectability of HCC and clarify the role of preoperative assessment on prognosis after living donor liver transplantation (LDLT). Methods: Eighty-one patients who underwent LDLT for HCC accompanied by liver cirrhosis were reviewed. A total of 149 nodules were pathologically diagnosed as HCCs. The pathologic findings were correlated with preoperative results from contrast-enhanced computed tomography, magnetic resonance imaging, and computed tomography with angiography. Results: The detectability of small HCCs (<1 cm) and well-differentiated HCCs was significantly reduced. Forty-six of 81 cases were preoperatively judged to meet the Milan criteria, although 16 of these failed to meet the criteria according to postoperative pathologic examination. However, recurrence-free survival in the 16 cases was similar to that in the 30 cases who met the criteria. Conclusions: The preoperative diagnostic accuracy of radiologic imaging for small-sized, well-differentiated HCCs requires improvement. However, these undetected HCCs have little effect on prognosis after LDLT, and current imaging modalities therefore provide acceptable methods of preoperative LDLT evaluation.
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