Multiphasic MDCT Enhancement Pattern of Hepatocellular Carcinoma Smaller Than 3 cm in Diameter: Tumor Size and Cellular Differentiation

Yoon, Soon Ho; Lee, Jeong Min; So, Young; Hong, Sung Hwan; Kim, Soo Jin; Han, Joon Koo; Choi, Byung Ihn

doi:10.2214/ajr.08.1818

Cited by 116 publications

(84 citation statements)

References 40 publications

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“…21 41-62% of lesions smaller than 2 cm showed either absence of arterial hypervascularity, venous washout or both. 22,23 Majority of cirrhotic nodules smaller than 1 cm are benign. 16 Whether this applies to the situation with HBV related HCC is questionable.…”

Section: If the Nodule Is Negative For Hepatocellular Carcinoma How Smentioning

confidence: 99%

Nodule in Liver: Investigations, Differential Diagnosis and Follow-up

Rao

2014

Journal of Clinical and Experimental Hepatology

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Conventional ultrasonogram of the abdomen being noninvasive, inexpensive and ubiquitously available is the first imaging modality that raises suspicion of HCC in a patient with chronic liver disease with or without cirrhosis. The lesions in liver particularly nodule are being recognized with increased frequency with the wide spread use of ultrasonogram as the initial investigation and computerized tomography and magnetic resonance imaging subsequently. Any nodule in a cirrhotic liver should be considered as hepatocellular carcinoma until otherwise proved. This approach certainly is helpful in diagnosing HCC at its earliest possible stage to offer meaningful curative measures be it transplant, resection or ablative therapy. After a nodule is detected on ultrasonogram the next imaging modality can be a contrast enhanced study (dynamic CT scan or an MRI) to see if are present or not. Two vital clues for diagnosis of HCC by contrast enhanced imaging are presence of arterial hypervascularity and washout which are considered as "classical imaging features". This sequence of events of arterial uptake followed by washout is highly specific for diagnosis of HCC by imaging. If the features are typical showing classical imaging features (i.e hypervascular in the arterial phase with washout in portal venous or delayed phase) the lesion should be treated as HCC biopsy is not necessary. Nodular lesions showing an atypical imaging pattern, such as iso-or hypovascular in the arterial phase or arterial hypervascularity alone without portal venous washout, should undergo further examinations with another contrast enhanced imaging. Biopsy is advisable for those lesions which do not show classical features on the imaging. ( J CLIN EXP HEPATOL 2014;4:S57-S62) T he diagnosis of HCC is predominantly by imaging modality. Conventional ultrasonogram of the abdomen being noninvasive, inexpensive and ubiquitously available is the first imaging modality that raises suspicion of HCC in a patient with chronic liver disease with or without cirrhosis. This could happen either on surveillance or de novo. At times, particularly in young patients with vertically transmitted HBV infection in Asia pacific and African continents it is not uncommon to come across advanced HCC at the time first presentation. The lesions in liver particularly nodule are being recognized with increased frequency with the wide spread use of ultrasonogram as the initial investigation and computerized tomography and magnetic resonance imaging subsequently. The most important question to be answered is to determine the nature of the nodule i.e. regenerating nodule, HCC, intrahepatic cholangiocarcinoma, metastatic lesion(s) or rarely an infective process. Any nodule in a cirrhotic liver should be considered as hepatocellular carcinoma until otherwise proved. This approach certainly is helpful in diagnosing HCC at its earliest possible stage to offer meaningful curative measures be it transplant, resection or ablative therapy. In this article we intend to answer two issues of ...

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Section: If the Nodule Is Negative For Hepatocellular Carcinoma How Smentioning

confidence: 99%

Nodule in Liver: Investigations, Differential Diagnosis and Follow-up

Rao

2014

Journal of Clinical and Experimental Hepatology

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“…have high chance of atypical enhancement pattern other than typical enhancement pattern of HCC (hypervascular at arterial phase and wash-out at portal and/or equilibrium phases) (24,25). In our study, the viable tumors in treated lesions that showed atypical enhancement pattern on MDCT were small (mean, 1.1 cm), which might be the main reason of false-negative CT results.…”

Section: Discussionmentioning

confidence: 54%

Gadoxetic acid‐enhanced MRI versus multiphase multidetector row computed tomography for evaluating the viable tumor of hepatocellular carcinomas treated with image‐guided tumor therapy

Hwang

Kim

et al. 2010

Magnetic Resonance Imaging

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Purpose: To compare the diagnostic performance of gadoxetic acid-enhanced MRI with that of multi-phase 40-or 64-multidetector row computed tomography (MDCT) to evaluate viable tumors of hepatocellular carcinomas (HCCs) treated with image-guided tumor therapy. Materials and Methods:A total of 108 patients with 162 HCCs (56 lesions with viable tumor and 106 without viable tumor) treated by means of transcatheter arterial chemoembolization or radiofrequency ablation were retrospectively included in this study. All patients underwent multi-phase CT at 40-or 64-MDCT and gadoxetic acidenhanced MRI using 3.0 Tesla (T). Two observers independently and randomly reviewed the CT and MR images of the treated lesions. The diagnostic performance of two techniques for the evaluation of the viable tumors in the treated lesions was assessed with a receiver operating characteristic (ROC) analysis.Results: For each observer, the areas under the ROC curve were 0.953 and 0.969 for MRI, and 0.870 and 0.888 for MDCT (P < 0.05). The diagnostic accuracies (96.3% for each observer) and sensitivities (92.9% and 96.4%) of MRI in two observers were significantly higher than those (82.7% and 80.9%, 53.6% for each observer, respectively) of MDCT (P < 0.001). The negative predictive values (96.3% and 98.1%) of MRI in two observers were significantly higher than those (80.0% and 79.5%) of MDCT (P < 0.001). For each observer, specificities and positive predictive values did not differ significantly between the two techniques (P > 0.05). Conclusion:Gadoxetic acid-enhanced MRI shows better diagnostic performance than that of MDCT for evaluating the viable tumors of HCCs treated with image-guided tumor therapy.

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“…Through the development of carcinogenesis, HCC gains vascularity and washout at the portal phase (2,23), and non-enhanced and hypervascular nodules without washout could be precancerous lesions, including early HCC (8,10). Nearly half of such tumors that were suspected to be HCC could have been placed under observation in this series.…”

Section: Discussionmentioning

confidence: 95%

“…Non-enhanced nodules > 2 cm in diameter had high malignant potential (26), and 41-62% of HCC smaller than 2 cm showed an atypical radiological pattern (1,10). In contrast, the majority of nodules in the cirrhotic liver < 1 cm are benign (8).…”

Section: Discussionmentioning

confidence: 99%

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Clinical correspondence to hepatocellular carcinoma-related lesions with atypical radiological pattern

Higaki

Midorikawa

Nakashima

et al. 2017

BST

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Multiphasic MDCT Enhancement Pattern of Hepatocellular Carcinoma Smaller Than 3 cm in Diameter: Tumor Size and Cellular Differentiation

Abstract: The prevalent enhancement patterns of HCC smaller than 3 cm on multiphasic MDCT scans differed depending on tumor size and cellular differentiation. HCCs smaller than 2 cm and well-differentiated HCCs frequently had atypical enhancement patterns.

Cited by 116 publications

References 40 publications

Nodule in Liver: Investigations, Differential Diagnosis and Follow-up

Nodule in Liver: Investigations, Differential Diagnosis and Follow-up

Gadoxetic acid‐enhanced MRI versus multiphase multidetector row computed tomography for evaluating the viable tumor of hepatocellular carcinomas treated with image‐guided tumor therapy

Clinical correspondence to hepatocellular carcinoma-related lesions with atypical radiological pattern

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