Evaluation of Hepatocellular Carcinoma Size Using Two-dimensional and Volumetric Analysis: Effect on Liver Transplantation Eligibility

Rationale and Objectives: Milan criteria recommends selection of candidates with hepatocellular carcinoma (HCC) for liver transplantation based on strict tumor size thresholds. The purpose of this study is to compare the effect of two-dimensional and three-dimensional tumor measurements on the selection of candidates for liver transplantation using Milan criteria. Materials and Methods: This retrospective Health Insurance Portability and Accountability Act-compliant study was approved by our institutional review board. Patient-informed consent was waived. Forty-five HCCs in 19 patients, evaluated with triphasic multidetector row computed scans, were included in the analysis. The largest diameters in each two-dimensional orthogonal plane tomography(Max2D) and within three-dimensional tumor boundaries (Max3D) were calculated for each lesion. Diameters were compared and the eligibility based on lesion size for liver transplantation was assessed. Results: The mean Max2D diameter of HCC was 3.2 ± 0.9 cm and the mean Max3D diameter was 3.5 ± 1.2 cm. There was a significant difference between the mean Max2D and Max3D diameters (P < .001). Among the 45 lesions, 22 of them (48.9%) were ineligible for transplantation according to Max2D diameter, whereas 29 of them (64.44%) were ineligible when Max3D diameter was applied (P < .001). Conclusion: HCC diameter based on 3D measurements is significantly different than the conventional 2D measurements and may affect eligibility for liver transplantation.