Radiological diagnosis of hepatocellular carcinoma

Abstract

Treatment of hepatocellular carcinomas (HCC) is often complicated by the fact that early HCCs are mostly asymptomatic and the carcinoma is often discovered at an advanced stage. The aim of diagnostic imaging is to detect HCC at an early stage, when curative options are available. In recent years, there have been many efforts to improve early detection of small HCC. The purpose of this article is to describe the pertinent findings of HCCs in non-invasive, diagnostic imaging, including ultrasound, computed tomography, as well as modern magnetic resonance imaging techniques. Special emphasis is given to the frequently addressed difficulties of differentiation of precancerous lesions and small HCCs. A non-invasive diagnostic approach is considered with a review of the literature.

Yttrium-90 microsphere radioembolization for the treatment of liver malignancies: a structured meta-analysis

“…In contrast, the relatively very low number of glass microspheres per dose is associated with microscopic embolization [39]. However, the low number of particles infused in the case of the glass microspheres may be a disadvantage when targeting a tumor type that is often diffusely spread throughout the liver at the time of diagnosis [44]; the radiation dose would be distributed in and around the tumors too heterogeneously to be able to deliver a tumoricidal dose to the entire lesion even if the total Y-RE arm alone c CT of 3 out of 36 patients not assessable amount of radioactivity of a dose of glass microspheres is at least 50% higher than is the case in the resin microspheres (Table 1). Another (theoretical) consideration is that the macroembolic effect of the resin microspheres is accompanied by a greater lack of oxygen resulting in ischemia and therefore enhanced efficacy.…”

Laparoscopic intra-operative ultrasound in liver and pancreas resection: Analysis of 93 cases

“…Preliminary results with contrast-enhanced intra-operative ultrasound (CEUS) have shown that this approach is more effective for detecting small liver lesions. It provided information not obtainable with conventional intra-operative ultrasound and modified the course of surgery in 79% of patients undergoing resection for hepatocellular carcinoma [7]. In the detection of liver metastases, it attained 96.1% sensitivity vs. 81.5% with plain ultrasound [8].…”

Surveillance and diagnosis of hepatocellular carcinoma in patients with cirrhosis

“…development of necrotic hypoechoic areas, calcifications and pseudocapsule). In these cases the presence of the "halo sign" and posterior enhancement increase the specificity of diagnosis [21,27,31] . arterial vascularization.…”

“…arterial vascularization. However, in small HCC and in lesions located deep within the liver parenchyma, the sensitivity of doppler is low and a typical arterial pulsatile flow arterial pattern is detected in only 50% of nodules [31,36] . Colour or power Doppler US of large HCC often demonstrate a basket pattern, with a fine blood network surrounding the nodule and flowing into it [37] .…”

“…Sensitivity ranges from 42% for lesions smaller than 1 cm [28,29] to 95% for tumors of larger size [30] . In pretransplant screening, the US sensitivity is poor because of the coarse echotexture of the liver, the frequent presence of ascites and the high rate of malignant lesions present in end-stage liver disease [31] . In a retrospective study on 200 patients who underwent liver transplantation, within 3 mo of previous screening, the US scanning was correlated with explanted livers, and had a sensitivity of only 13.6% to 50% for lesions of 1-5 cm in diameter [32] .…”