Hepatic Angiomyolipoma Difficult to Distinguish from Hepatocellular Carcinoma Using Conventional Imaging Studies

Twenty-two patients with 37 small (3 cm or less) nodular lesions of hepatocellular carcinoma (HCC) were examined with ultrasonography (US), CT, MR imaging, digital subtraction angiography (DSA), and CT following intraarterial injection of Lipiodol (Lipiodol-CT). All patients subsequently underwent surgery, and the gold standard was provided by intraoperative US. The detection rate was 70% for US, 65% for CT, 62% for MR imaging, 73% for DSA, and 86% for Lipiodol-CT. A significant difference (p<0.05) was observed between the detection rate of Lipiodol-CT and the detection rates of all the other imaging modalities. The difference was even more manifest (p<0.02) when only lesions smaller than or equal to 1 cm were considered. It is concluded that Lipiodol-CT is the single most sensitive examination to detect small nodules of HCC. It should therefore be considered a mandatory step in the preoperative evaluation of patients with HCC considered to be surgical candidates after noninvasive imaging studies.

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A case of hepatic angiomyolipoma mimicking hepatocellular carcinoma

Kanzo ◽

10.2957/kanzo.54.479 ◽

2013 ◽

Vol 54 (7) ◽

pp. 479-485

Author(s):

Masanobu Taguchi ◽

Masanobu Hyodo ◽

Kazue Morishima ◽

Atsushi Shimizu ◽

Naohiro Sata ◽

...

Keyword(s):

Hepatocellular Carcinoma ◽

Hepatic Angiomyolipoma

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Effective localization in tumor-induced osteomalacia using 68Ga-DOTATOC-PET/CT, venous sampling and 3T-MRI

Endocrinology Diabetes and Metabolism Case Reports ◽

10.1530/edm-17-0005 ◽

2017 ◽

Vol 2017 ◽

Cited By ~ 4

Author(s):

Shintaro Kawai ◽

Hiroyuki Ariyasu ◽

Yasushi Furukawa ◽

Reika Yamamoto ◽

Shinsuke Uraki ◽

...

Keyword(s):

Fibroblast Growth Factor 23 ◽

Somatostatin Receptor ◽

List Type ◽

Conventional Imaging ◽

Imaging Studies ◽

Venous Sampling ◽

3T Mri ◽

Positron Emission ◽

Pet Ct ◽

The Right

Summary Tumor-induced osteomalacia (TIO) is a rare paraneoplastic syndrome characterized by renal phosphate wasting leading to hypophosphatemia due to excessive actions of fibroblast growth factor 23 (FGF23) produced by the tumors. Although the best way of curing TIO is complete resection, it is usually difficult to detect the culprit tumors by general radiological modalities owing to the size and location of the tumors. We report a case of TIO in which the identification of the tumor by conventional imaging studies was difficult. Nonetheless, a diagnosis was made possible by effective use of multiple modalities. We initially suspected that the tumor existed in the right dorsal aspect of the scapula by 68Ga-DOTATOC positron emission tomography/computed tomography (68Ga-DOTATOC-PET/CT) and supported the result by systemic venous sampling (SVS). The tumor could also be visualized by 3T-magnetic resonance imaging (MRI), although it was not detected by 1.5T-MRI, and eventually be resected completely. In cases of TIO, a stepwise approach of 68Ga-DOTATOC-PET/CT, SVS and 3T-MRI can be effective for confirmation of diagnosis. Learning points: TIO shows impaired bone metabolism due to excessive actions of FGF23 produced by the tumor. The causative tumors are seldom detected by physical examinations and conventional radiological modalities. In TIO cases, in which the localization of the culprit tumors is difficult, 68Ga-DOTATOC-PET/CT should be performed as a screening of localization and thereafter SVS should be conducted to support the result of the somatostatin receptor (SSTR) imaging leading to increased diagnosability. When the culprit tumors cannot be visualized by conventional imaging studies, using high-field MRI at 3T and comparing it to the opposite side are useful after the tumor site was determined.

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