- Hepatocellular Carcinoma
- 3rd leading cause of death worldwide
- Strong male predilection
- Risk factors:
- Hepatitis B and C
- Cirrhosis
- Fatty liver
- Management options
- Surgery, chemoembolization, transplant
- Hepatocellular Carcinoma
1. 3rd leading cause of death worldwide
2. Strong male predilection
3. Risk factors:
- Hepatitis B and C
- Cirrhosis
- Fatty liver
4. Management options
- Surgery, chemoembolization, transplant - Hepatocellular Carcinoma
1. Overall MDCT sensitivity for HCC is 90%+
2. Sensitivity 60% for lesions < 2 cm
- False positives increase for small lesions
3. Three patterns:
- Solitary
- Multifocal
- Diffuse - Hepatocellular Carcinoma
1. Hypervascular in the arterial phase
- Homogeneous for lesions < 3 cm
2. Washout in the venous or delayed phase
3. Encapsulated, with enhancement of capsule on delayed images
4. Can have a central scar
5. Fat
6. Hemorrhage - LIRADS
Liver Imaging Reporting and Data System
- LIRADS 1: Definitely Benign
- LIRADS 2: Probably Benign
- LIRADS 3: Intermediate Probability for HCC
- LIRADS 4: Probably HCC
- LIRADS V: Definitely HCC - Fibrolamellar HCC
1. Young patients without cirrhosis
2. Theoretically less aggressive
3. Large, aggressive looking (lobulated)
4. Hypervascular with delayed washout
- Encapsulated
- Central scar – Ca++
5. Adenopathy common - Solid Malignant Masses
1. Metastases
- Hypovascular
- Hypervascular
2. Cholangiocarcinoma
3. Lymphoma
4. Hepatic Sarcoma
5. Epithelioid Hemangioendothelioma
- Hepatoma: Facts
- Commonly develops in the setting of chronic liver disease especially in patients with Hepatitis B and C
- The median survival following diagnosis is 8-20 months
- Clinical presentation includes cirrhotic patients who develop decompensation including ascites, encephalopathy, jaundice or variceal bleeding
- Patients may also present with abdominal pain, weight loss or a palpable mass
- Cirrhosis: Common Causes
- Alcohol abuse (the most common cause in the United States)
- Autoimmune diseases of the liver
- Hepatitis B or C virus infection
- Inflammation of the liver that is long-term (chronic)
- Iron overload in the body (hemachromatosis) - “Each year 50000 to 1 million individuals are diagnosed with hepatocellular carcinoma (HCC) worldwide. Incidence rates demonstrate dramatic geographic variability, ranging from<5 new cases per 100000 persons per year in developed western countries to>100 per 100000 persons per year in parts of south-east Asia and sub-Saharan Africa. Although the United States is among regions of low incidence, a 70% increase in HCC has been observed over the past two decades, apparently related to the emergence of chronic hepatitis C.”
Diagnosis of Hepatocellular Carcinoma
Bialecki ES, Di Bisceglie AM
HPB 2005;7(1):26-34 - “Brancatelli etal. describe hepatic lesions which can mimic HCC on CT imaging including regenerating nodules, hemangiomas, focal fat, dysplastic nodules, and peliosis. The accuracy increases with greater imaging speed, which allows faster administration of contrast media, thereby dramatically improving contrast enhancement . The added speed and flexibility of multidetector CT (MDCT) allows high quality, thin-section imaging with three-dimensional capabilities .”
Diagnosis of Hepatocellular Carcinoma
Bialecki ES, Di Bisceglie AM
HPB 2005;7(1):26-34
"MDCT has reasonable sensitivity in the detection of hepatocellular carcinoma in patients with cirrhosis who undergo liver transplantation. Attention should be paid, however, to avoiding overestimation of the extent of disease."
Role of MDCT in the Diagnosis of Hepatocellular Carcinoma in Patients with Cirrhosis Undergoing Orthotopic Liver Transplantation
Ronzoni A et al
AJR 2007;189;792-798
"The more accurate and detailed pretreatment evaluation of HCC progression using a unified CTA system contributed to the improvement of survival of patients with HCC." Impact of a Unified CT Angiography System on Outcome of Patients with Hepatocellular Carcinoma
Toyoda H et al.
AJR 2009; 192:766-774 "The more accurate and detailed pretreatment evaluation of HCC progression using a unified CTA system contributed to the improvement of survival of patients with HCC. In addition it contributed to the improved efficacy of TACE with an increased survival rate." Impact of a Unified CT Angiography System on Outcome of Patients with Hepatocellular Carcinoma
Toyoda H et al.
AJR 2009; 192:766-774
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