MR imaging in diffuse-type hepatocellular carcinoma with synchronous portal vein thrombi

Haliloğlu, Nuray; Özkavukçu, Esra; Erden, Ayşe; Erden, İlhan

doi:10.4318/tjg.2011.0185

Cited by 7 publications

(14 citation statements)

References 16 publications

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“…The enhancement pattern of infiltrative HCC seen on images obtained during the hepatic arterial phase has been reported as minimal, patchy, or miliary (10,13,17,32,39) (Figs 2, 3, 5, 6). Although arterial hyperenhancement is a key diagnostic feature of nodular and massive HCC, infiltrative HCC may commonly appear as iso-or hypointense on images obtained during the arterial phase (33,34).…”

Section: Contrast-enhanced Ct and Mr Imagingmentioning

confidence: 94%

“…Infiltrative HCC accounts for approximately 7%-20% of HCC cases (9,(11)(12)(13)(14)(15) and is reported to be commonly associated with hepatitis B virus infection, particularly in Asia (9,16). Patients with infiltrative HCC may have markedly elevated a-fetoprotein (AFP) values (>10,000 ng/mL) (10,13,17). However, AFP serum level measurement has poor accuracy for diagnosis of HCC (12), and patients with infiltrative HCC may have normal (<20 ng/mL) or only mildly elevated (<400 ng/mL) levels (10,12,13).…”

Section: Imaging Modalities For Diagnosis Of Hccmentioning

confidence: 97%

“…This pattern translates as a permeative ill-defined appearance at US, CT, and MR imaging. Infiltrative HCC usually spreads over multiple hepatic segments, occupying an entire lobe or the entire liver (10,13,17). Moreover, multiple smaller satellite lesions are reported in up to 52% of cases (10,32).…”

Section: Imaging Of Infiltrative Hccmentioning

confidence: 97%

“…Moreover, because of the permeative appearance and subtle enhancement of the tumor, portal vein thrombosis may appear as the primary imaging feature (33). Hepatic venous thrombosis is reported less frequently (17). The uses, pitfalls, and limitations of US, CT, and MR imaging for facilitating the diagnosis of infiltrative HCC are described below and summarized in Table 1.…”

Section: Imaging Of Infiltrative Hccmentioning

confidence: 98%

“…Portal vein tumor thrombosis is a common finding in patients with infiltrative HCC, often affecting both extra-and intrahepatic branches (10,13,17,(32)(33)(34), with a frequency ranging from 68% to 100%. Moreover, because of the permeative appearance and subtle enhancement of the tumor, portal vein thrombosis may appear as the primary imaging feature (33).…”

Section: Imaging Of Infiltrative Hccmentioning

confidence: 99%

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Infiltrative Hepatocellular Carcinoma: What Radiologists Need to Know

Reynolds¹,

Furlan²,

Fetzer³

et al. 2015

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Hepatocellular carcinoma (HCC) is one of the leading causes of cancer-related death worldwide. The macroscopic growth pattern of HCC is subdivided into three categories: nodular, massive, and infiltrative. Infiltrative HCC accounts for 7%-20% of HCC cases and is confirmed at pathologic analysis on the basis of the spread of minute tumor nodules throughout large regions of the liver. Infiltrative HCC may represent a diagnostic challenge because it is often difficult to distinguish from background changes in cirrhosis at imaging. Infiltrative HCC usually spreads over multiple hepatic segments, occupying an entire hepatic lobe or the entire liver, and it is frequently associated with portal vein tumor thrombosis. The tumor is usually ill defined at ultrasonography and shows minimal and inconsistent arterial enhancement and heterogeneous washout at contrast material-enhanced computed tomography and magnetic resonance (MR) imaging. The tumor may be more visible among the surrounding liver parenchyma at diffusion-, T1-, and T2-weighted MR imaging. Several liver diseases can mimic the infiltrative appearance of this malignancy, including focal confluent fibrosis, hepatic fat deposition, hepatic microabscesses, intrahepatic cholangiocarcinoma, and diffuse metastatic disease (pseudocirrhosis). The prognosis for patients with infiltrative HCC is poor because the tumor is often markedly advanced and associated with vascular invasion at presentation. Survival after surgical resection is decreased; thus, infiltrative HCC is a contraindication for resection and transplantation. Knowledge of the key tumor characteristics and imaging findings will help radiologists formulate a correct and timely diagnosis to improve patient management.

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