Distinct MDCT imaging features to differential diagnosis of hepatic paragonimiasis and small hepatocellular carcinoma

Abstract

We used multi-row detector computed tomography (MDCT) to identify the distinguishing characteristics of hepatic paragonimiasis and small hepatocellular carcinoma lesions. We analyzed a cohort of 60 patients, of which 26 had hepatic paragonimiasis and 34 with a small (≤ 3cm) hepatocellular carcinoma. MDCT detected 65 lesions that were retrospectively reviewed and analyzed based on their imaging features. Both groups showed distinct MDCT imaging features that could contribute to an accurate diagnosis. In the paragonimiasis group, 75% (21/28) lesions were located in the hepatic subcapsular region, whereas only 10.8% (4/37) of lesions in the hepatocellular carcinoma group were subcapsular. Most hepatic paragonimiasis lesions (57.1%; 16/28) also showed characteristic tubular or tunnel features that were not present in hepatocellular carcinomas. Further, 71.4% (20/28) paragonimiasis lesions were rim enhanced with irregular tract-like non-enhanced internal areas with a characteristic target loop, while 94.6% (35/37) of small hepatocellular carcinoma lesions showed homogenous enhancement in the arterial and venous phase. In addition, the period CT values for hepatic paragonimiasis were less than those of hepatic carcinomas (P<0.001). These clinically significant findings illustrate the diagnostic features that enable one to distinguish hepatic paragonimiasis from small hepatocellular carcinomas.

A case of hepatic paragonimiasis was misdiagnosed as hepatocellular carcinoma with rupture and haemorrhage

“…With regard to the CT imaging findings, a previous study proposed that the relationship between the mass and liver capsule, the CT value difference and whether there is a ‘tunnel sign’ in multidetector CT manifestations are helpful to distinguish hepatocellular carcinoma from hepatic paragonimiasis. 4 The patient's CT imaging findings met some of the above features, however the patient was still misdiagnosed based on the CT findings because of two reasons: (i) the incomplete consideration of parasitic disease by the imaging physicians; and (ii) there have been very few cases of rupture and haemorrhage in the mass caused by hepatic paragonimiasis reported in the literature. 5 This case demonstrates that there are difficulties in the differential diagnosis of liver paragonimiasis based on CT imaging and the gold standard for a final diagnosis remains pathology.…”

MDCT Evaluation of Hepatic Manifestations in Malignant Hematological Disorders

“…The prominent role of computed tomography multidetector is primarily defined by its excellent ability to depict morphologic characteristics, in particular in clinical scenarios of diffuse or focal intrahepatic lesions as well as anatomic relationships between the liver and adjacent organs [3,4]. In the present study, we aimed to evaluate multidetector Computed Tomography findings of hepatic manifestation in common malignant hematological disorders.…”