DIAGNOSTIC ACCURACY OF QUANTITATIVE WASHOUT IN DIAGNOSINGHEPATOCELLULAR CARCINOMA
DOI:
https://doi.org/10.71000/ajs39t47Keywords:
Triphasic CT, Hepatocellular carcinoma, Chronic liver disease, Computed Tomography, Diagnostic Accuracy, Histopathology, Imaging BiomarkersAbstract
Background: Hepatocellular carcinoma (HCC) is the most prevalent primary liver malignancy and remains a leading cause of cancer-related deaths worldwide. The condition is often associated with chronic liver disease (CLD), particularly in high-prevalence regions like Pakistan. Timely and accurate diagnosis plays a crucial role in improving treatment outcomes. Quantitative washout on triphasic computed tomography (CT) has emerged as a promising non-invasive imaging biomarker for HCC, offering objective assessment of lesion behavior during contrast-enhanced phases.
Objective: To determine the diagnostic accuracy of quantitative washout on triphasic CT in diagnosing hepatocellular carcinoma, using histopathological findings as the gold standard.
Methods: A cross-sectional study was conducted at the Dow Institute of Radiology, Dow University of Health Sciences, from 11th October 2024 to 11th April 2025. A total of 192 patients aged 30–80 years with clinical suspicion of HCC underwent triphasic CT scans. Delayed phase attenuation values were measured to calculate quantitative washout. All patients subsequently underwent liver biopsy, and histopathology served as the reference standard. Data analysis was performed using SPSS version 22.0. Sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and overall diagnostic accuracy were calculated using 2 × 2 contingency tables.
Results: The mean age of participants was 54.49 ± 10.88 years, with 124 (64.6%) males and 68 (35.4%) females. Mean quantitative washout was 141.99 ± 28.63 Hounsfield Units. Quantitative washout on CT identified HCC in 170 (88.5%) patients, while histopathology confirmed HCC in 162 (84.4%). The diagnostic parameters showed sensitivity of 100.00%, specificity of 73.33%, PPV of 95.29%, NPV of 100.00%, and diagnostic accuracy of 95.83%.
Conclusion: Quantitative washout on triphasic CT is a highly sensitive and accurate imaging technique for diagnosing hepatocellular carcinoma, supporting its integration into diagnostic protocols for CLD patients.
References
Marks RM, Fung A, Cruite I, Blevins K, Lalani T, Horvat N, et al. The adoption of LI-RADS: a survey of non-academic radiologists. Abdom Radiol (NY). 2023;48(8):2514-24.
Hwang JA, Min JH, Kang TW, Jeong WK, Kim YK, Ko SE, et al. Assessment of factors affecting washout appearance of hepatocellular carcinoma on CT. Eur Radiol. 2021;31(10):7760-70.
She Y, Liu X, Liu H, Yang H, Zhang W, Han Y, et al. Combination of clinical and spectral-CT iodine concentration for predicting liver metastasis in gastric cancer: a preliminary study. Abdom Radiol (NY). 2024;49(10):3438-49.
Kan NN, Yu CY, Cheng YF, Hsu CC, Chen CL, Hsu HW, et al. Combined Hounsfield units of hepatocellular carcinoma on computed tomography and PET as a noninvasive predictor of early recurrence after living donor liver transplantation: Time-to-recurrence survival analysis. Eur J Radiol. 2024;177:111551.
Lee S, Kim YY, Shin J, Hwang SH, Roh YH, Chung YE, et al. CT and MRI Liver Imaging Reporting and Data System Version 2018 for Hepatocellular Carcinoma: A Systematic Review With Meta-Analysis. J Am Coll Radiol. 2020;17(10):1199-206.
van der Pol CB, McInnes MDF, Salameh JP, Levis B, Chernyak V, Sirlin CB, et al. CT/MRI and CEUS LI-RADS Major Features Association with Hepatocellular Carcinoma: Individual Patient Data Meta-Analysis. Radiology. 2022;302(2):326-35.
Kitao A, Matsui O, Zhang Y, Ogi T, Nakada S, Sato Y, et al. Dynamic CT and Gadoxetic Acid-enhanced MRI Characteristics of P53-mutated Hepatocellular Carcinoma. Radiology. 2023;306(2):e220531.
Cannella R, Zins M, Brancatelli G. ESR Essentials: diagnosis of hepatocellular carcinoma-practice recommendations by ESGAR. Eur Radiol. 2024;34(4):2127-39.
Xie T, Liu W, Chen L, Zhang Z, Chen Y, Wang Y, et al. Head-to-head comparison of contrast-enhanced CT, dual-layer spectral-detector CT, and Gd-EOB-DTPA-enhanced MR in detecting neuroendocrine tumor liver metastases. Eur J Radiol. 2024;181:111710.
Cunha GM, Fowler KJ, Abushamat F, Sirlin CB, Kono Y. Imaging Diagnosis of Hepatocellular Carcinoma: The Liver Imaging Reporting and Data System, Why and How? Clin Liver Dis. 2020;24(4):623-36.
Pan J, Huang H, Zhang S, Zhu Y, Zhang Y, Wang M, et al. Intraindividual comparison of CT and MRI for predicting vessels encapsulating tumor clusters in hepatocellular carcinoma. Eur Radiol. 2025;35(1):61-72.
Ichikawa S, Goshima S. Key CT and MRI findings of drug-associated hepatobiliary and pancreatic disorders. Jpn J Radiol. 2024;42(3):235-45.
Galgano SJ, Smith EN. LI-RADS Version 2018 for MRI and CT: Interreader Agreement in Real-World Practice. Radiology. 2023;307(5):e231212.
Görgec B, Hansen IS, Kemmerich G, Syversveen T, Abu Hilal M, Belt EJT, et al. MRI in addition to CT in patients scheduled for local therapy of colorectal liver metastases (CAMINO): an international, multicentre, prospective, diagnostic accuracy trial. Lancet Oncol. 2024;25(1):137-46.
Hong CW, Chernyak V, Choi JY, Lee S, Potu C, Delgado T, et al. A Multicenter Assessment of Interreader Reliability of LI-RADS Version 2018 for MRI and CT. Radiology. 2023;307(5):e222855.
Ruan L, Yu J, Lu X, Numata K, Zhang D, Liu X, et al. A Nomogram Based on Features of Ultrasonography and Contrast-Enhanced CT to Predict Vessels Encapsulating Tumor Clusters Pattern of Hepatocellular Carcinoma. Ultrasound Med Biol. 2024;50(12):1919-29.
Yang Q, Zheng R, Zhou J, Tang L, Zhang R, Jiang T, et al. On-Site Diagnostic Ability of CEUS/CT/MRI for Hepatocellular Carcinoma (2019-2022): A Multicenter Study. J Ultrasound Med. 2023;42(12):2825-38.
Wu H, Liang Y, Wang Z, Tan C, Yang R, Wei X, et al. Optimizing CT and MRI criteria for differentiating intrahepatic mass-forming cholangiocarcinoma and hepatocellular carcinoma. Acta Radiol. 2023;64(3):926-35.
Lee S, Kim YY, Shin J, Son WJ, Roh YH, Choi JY, et al. Percentages of Hepatocellular Carcinoma in LI-RADS Categories with CT and MRI: A Systematic Review and Meta-Analysis. Radiology. 2023;307(1):e220646.
Kruczkowska W, Gałęziewska J, Kciuk M, Kałuzińska-Kołat Ż, Zhao LY, Kołat D. Radiomics and clinicoradiological factors as a promising approach for predicting microvascular invasion in hepatitis B-related hepatocellular carcinoma. World J Gastroenterol. 2025;31(11):101903.
Franzè MS, Bottari A, Caloggero S, Pitrone A, Barbera A, Lembo T, et al. Rate of hepatocellular carcinoma diagnosis in cirrhotic patients with ultrasound-detected liver nodules. Intern Emerg Med. 2021;16(4):949-55.
Johnson SA. Reliability of LI-RADS for MRI and CT: Is Excellence Achievable? Radiology. 2023;307(5):e231066.
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Copyright (c) 2025 Nighat Hasan, Samita Asad, Aniqa Qureshi, Anmol Fariha, Javeria Sattar, Sara, Syed Hameed-Ul-Hassan Shah (Author)
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