Introduction: The United Network for Organ Sharing (UNOS) requires confirmation of HCC based on imaging to be made at a transplant center. This places a burden on transplant centers to repeat already-performed imaging evaluation. Methods: One-hundred and five consecutive cases presented for hepatocellular carcinoma (HCC) at multidisciplinary HCC conference were reviewed to compare the radiologic reads of computed tomography (CT) and magnetic resonance imaging (MRI) between those at outside institutions versus at our transplant center. Only the initial CT or MRI study was used for each patient. The specific features of imaging reads evaluated were the number of lesions, size of lesions, arterial hypervascularity, delayed or venous washout, presence of pseudocapsule, and Liver Imaging Reporting and Data System (LIRADS) score. We assessed whether these features were commented on in the report and noted discrepancies between the outside and Scripps reads. Results: Overall, 50 of those patients were from outside centers. Thirty-nine of the imaging studies were MRI, while 11 were CT. In total, 60 lesions were noted on outside imaging while 62 were noted on Scripps reads. Of note however, some reads noted “multiple” lesions that were not quantified. In total, there were 10 discrepancies (16%) in number of lesions identified, most of which were one lesion less or more from the original read. Three were lesions identified solely on review at our institution and two of these lesions were HCC, while the other lesion was not seen on repeat imaging. Average size discrepancy was 2.3 mm in lesions whose sizes could be directly compared. Of the 60 outside lesions noted, 56 documented presence or absence of arterial hypervascularity, 32 documented presence or absence of portal venous washout, 9 documented presence or absence of pseudocapsule and 5 documented presence or absence of vascular invasion. Only 2 outside reads (<1%) mentioned LIRADS score. Conclusion: Overall, the accuracy of imaging reads at non-transplant centers is comparable in terms of number of lesions and size of lesions. However, 2 hepatocellular carcinomas were missed on outside reads. Additionally, the required radiologic features for liver lesions were incompletely commented on in the vast majority of outside imaging reads. While re-reading imaging from outside centers places a burden on transplant centers, at this time it appears to be an important aspect of care.

CITATION INFORMATION: Kardashian A, Madani B, Frenette C. Re-Evaluation of Imaging Studies in Patients with Hepatocellular Carcinoma at a Transplant Center Impacts Patient Care. Am J Transplant. 2017;17 (suppl 3).

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