Nontumorous arterioportal shunt mimicking hypervascular tumor in cirrhotic liver: two-phase spiral CT findings.

Kim, Tae Kyoung; Choi, Byung Ihn; Han, Joon Koo; Chung, Jin Wook; Park, J H; Han, Man Chung

doi:10.1148/radiology.208.3.9722834

Cited by 163 publications

(99 citation statements)

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“…Despite these drawbacks, favorable results for cumulative survival rate, intrahepatic tumor progression rate and tumor-free survival were obtained, indicating that even small HCCs <3 cm in diameter possess microscopic disseminated disease, depending on gross morphology. Patients with cirrhosis commonly have fine arterioportal shunts and hepatofugal blood flow (32). Anticancer drugs administered during TACE are thought to be washed out immediately, except for Miripla (33), but these drugs are likely to be carried in blood that flows outside subsegments or the entire liver, via the same hemodynamic route used in the dissemination of liver cancer cells.…”

Section: Univariate Multivariate ------------------------------------mentioning

confidence: 99%

Utility of percutaneous radiofrequency ablation alone or combined with transarterial chemoembolization for early hepatocellular carcinoma

et al. 2017

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Abstract. Percutaneous radiofrequency ablation (RFA) combined with transarterial chemoembolization (TACE) is an effective, standard therapy against small hepatocellular carcinoma (HCC). However, there is debate regarding the effectiveness of RFA combined with TACE (RFA/TACE) compared with RFA alone. These two approaches were compared for the treatment of early HCC. The present study examined 83 HCC tumors in 83 patients treated with RFA between April 2007 and August 2014 at three medical institutions. All HCCs were single hypervascular tumors, with a median diameter of 16 mm (range, 6-30 mm). The overall survival (OS) rate of all patients (n=83) was 97.5% at 1 year, 82.8% at 3 years and 48.6% at 5 years, and the local recurrence rate of all patients was 14.3% at 1 year, 32.3% at 3 years and 36.5% at 5 years. The tumor-free survival (TFS) rate of all patients was 95.1% at 1 year, 56.3% at 3 years and 23.4% at 5 years. Compared with RFA alone, RFA/TACE significantly improved OS (P<0.001), intrahepatic distant recurrence (IDR; P=0.038) and TFS (P=0.010). A univariate analysis of prognostic indicators revealed that age <70 years (P=0.008), aspartate transaminase <40 IU/l (P=0.003), alanine aminotransferase <40 IU/l (P=0.006) and platelet count >10x10 4 /µl (P=0.05) were associated with a high survival rate. Multivariate analysis identified RFA/TACE [hazard ratio (HR), 0.108; P=0.001] as an independent prognostic indicator. RFA/TACE was identified as the only independent indicator of IDR (HR: 0.467; P=0.042) and TFS (HR: 0.452; P=0.012). RFA/TACE improved OS rate, IDR and TFS compared with RFA alone. The data suggested that RFA/TACE should be considered for the treatment of single hypervascular HCC.

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Section: Univariate Multivariate ------------------------------------mentioning

confidence: 99%

Utility of percutaneous radiofrequency ablation alone or combined with transarterial chemoembolization for early hepatocellular carcinoma

et al. 2017

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“…However, 46 of the 64 lesions followed up were not confirmed to be HCC. Some of these lesions may be non-tumorous arterioportal shunts which showed wedge-shaped hyperattenuating lesions at the hepatic arterial phase and their attenuation during the portal venous phase never decreased below that of the surrounding liver parenchyma [24]. Furthermore, some of these lesions may be regenerative nodules in cirrhotic liver, which were visualized as enhancing nodules surrounded by lower attenuation tin septa during CTAP and non-enhancing nodules surrounded by enhancing fibrous septa during CTHA [25].…”

Section: Discussionmentioning

confidence: 99%

Outcome of small liver nodules detected by computed tomographic angiography in patients with hepatocellular carcinoma

et al. 2010

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Purpose Hepatic lesions identified by computed tomography (CT) during arterial portography (CTAP) or CT hepatic arteriography (CTHA) in hepatocellular carcinoma (HCC) patients are sometimes too small to be diagnosed as HCC. We undertook this cohort study to assess whether these small lesions are actually HCC, and to clarify the effectiveness of these imaging examinations in a clinical setting. Methods We assessed the characteristics of 74 tiny lesions detected by CTAP and/or CTHA, but not by CT in 67 patients. Results Seven out of 10 nodules were histologically confirmed as HCC and 18 out of 64 lesions increased in size and showed typical findings of HCC during the followup period. Multivariate analysis revealed that the size of the main tumor ([30 mm in diameter) was associated with the presence of tiny additional HCC lesions (P = 0.002). Conclusions These findings indicate that CTAP and CTHA are recommended for determining the stage of HCC, especially when the HCC nodule is larger than 30 mm in diameter.

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“…In a cirrhotic liver, early reports suggested that virtually all arterial-enhancing lesions are HCC. However, arterial enhancement may be seen in a regenerating nodule, nontumor arterio-portal shunt, and aberrant venous drainage in a cirrhotic liver [8,26,27] . Our series demonstrated that arterial enhancement also occurred in MRN of BA patients.…”

Section: Discussionmentioning

confidence: 99%

Macro-regenerative nodules in biliary atresia: CT/MRI findings and their pathological relations

Liang¹,

Cheng²,

Concejero³

et al. 2008

WJG

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AIM:To describe the radiological findings of a macro-regenerative nodule (MRN) in the liver of pretransplantation biliary atresia (BA) patients and to correlate it with histological findings. METHODS: Between August 1990 and November 2007, 144 BA patients underwent liver transplantation (LT) at our institution. The pre-transplantation computer tomography (CT) and magnetic resonance imaging (MRI) findings were reviewed and correlated with the post-transplantation pathological findings. RESULTS: Nine tumor lesions in 7 patients were diagnosed in explanted livers. The post-transplantation pathological findings showed that all the lesions were MRNs without malignant features. No small nodule was detected by either MRI or CT. Of the 8 detectable lesions, 6 (75%) were in the central part of the liver, 5 (63%) were larger than 5 cm, 5 (63%) had intratumor tubular structures, 3 (38%) showed enhancing fibrous septa, 3 (38%) had arterial enhancement in CT, one (13%) showed enhancement in MRI, and one (13%) had internal calcifications. CONCLUSION: Although varied in radiological a p p e a ra n c e , M R N c a n b e d i f f e r e n t i a t e d f r o m hepatocellular carcinoma (HCC) in most of BA patients awaiting LT. The presence of an arterial-enhancing nodule does not imply that LT is withheld solely on the basis of presumed malignancy by imaging studies. Liver biopsy may be required in aid of diagnostic imaging to exclude malignancy.

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Nontumorous arterioportal shunt mimicking hypervascular tumor in cirrhotic liver: two-phase spiral CT findings.

Cited by 163 publications

References 0 publications

Utility of percutaneous radiofrequency ablation alone or combined with transarterial chemoembolization for early hepatocellular carcinoma

Utility of percutaneous radiofrequency ablation alone or combined with transarterial chemoembolization for early hepatocellular carcinoma

Outcome of small liver nodules detected by computed tomographic angiography in patients with hepatocellular carcinoma

Macro-regenerative nodules in biliary atresia: CT/MRI findings and their pathological relations

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