Detectability of Hypervascular Hepatocellular Carcinoma by Arterial Phase Images of MR and Spiral CT

The ability of arterial phase images of breath-hold MR imaging and spiral CT to detect hypervascular hepatocellular carcinomas (HCCs) was evaluated. Prior to transcatheter arterial chemoembolization (TACE) with iodized oil, MR images and spiral CT during i.v. bolus injection of contrast medium (IV-MR imaging and IV-spiral CT) and spiral CT during intraarterial injection of contrast media through catheter (IA-spiral CT) of the entire liver were obtained in 24 consecutive patients with 93 HCCs. In the detection of HCCs less than 1 cm in diameter, IA-spiral CT (87.3%) was superior to IV-MR imaging (63.5%) and IV-spiral CT (54.0%) (p<0.001). There was no significant difference in detectability in any tumor size between IV-MR imaging and IV-spiral CT. IA-spiral CT was the best for detecting hypervascular HCCs, and there was no significant difference between IV-MR imaging and IV-spiral CT.

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Hepatobiliary phase images of gadoxetic acid-enhanced MRI may improve accuracy of predicting the size of hepatocellular carcinoma at pathology

Acta Radiologica ◽

10.1177/02841851211014194 ◽

2021 ◽

pp. 028418512110141

Author(s):

San-Yuan Dong ◽

Yu-Tao Yang ◽

Wen-Tao Wang ◽

Shuo Zhu ◽

Wei Sun ◽

...

Keyword(s):

Hepatocellular Carcinoma ◽

Correlation Coefficient ◽

Tumor Size ◽

Pearson Correlation ◽

Gadoxetic Acid ◽

Arterial Phase ◽

Hepatobiliary Phase ◽

Enhanced Mri ◽

Phase Images ◽

Mri Sequences

Background Gadoxetic acid-enhanced magnetic resonance imaging (MRI) has been widely used in clinical practice. However, scientific evidence is lacking for recommending a particular sequence for measuring tumor size. Purpose To retrospectively compare the size of hepatocellular carcinoma (HCC) measured on different gadoxetic acid-enhanced MRI sequences using pathology as a reference. Material and Methods A total of 217 patients with single HCC who underwent gadoxetic acid-enhanced MRI before surgery were included. The size of the HCC was measured by two abdominal radiologists independently on the following sequences: T1-weighted; T2-weighted; b-500 diffusion-weighted imaging (DWI); and arterial, portal venous, transitional, and hepatobiliary phases. Tumor size measured on MRI was compared with pathological size by using Pearson correlation coefficient, independent-sample t test, and Bland–Altman plot. Agreement between two readers was evaluated with intraclass correlation coefficient (ICC). Results Correlation between the MR images and pathology was high for both readers (0.899–0.955). Absolute error between MRI and pathologic assessment was lowest on hepatobiliary phase images for both readers (reader 1, 2.8±4.2 mm; reader 2, 3.2±3.4 mm) and highest on arterial phase images for reader 1 (4.9±4.4 mm) and DWI phase images for reader 2 (5.1±4.9 mm). Absolute errors were significantly different for hepatobiliary phase compared with other sequences for both readers (reader 1, P≤0.012; reader 2, P≤0.037). Inter-reader agreements for all sequence measurements were strong (0.971–0.997). Conclusion The performance of gadoxetic acid-enhanced MRI sequences varied with HCC size, and the hepatobiliary phase may be optimal among these sequences.

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A Case of Hepatic Angiomyolipoma Which Was Misdiagnosed as Hepatocellular Carcinoma in a Hepatitis B Carrier

Case Reports in Hepatology ◽

10.1155/2012/606108 ◽

2012 ◽

Vol 2012 ◽

pp. 1-5

Author(s):

Jin Yeon Hwang ◽

Sung Wook Lee ◽

Yang Hyun Baek ◽

Jong Han Kim ◽

Ha Yeon Kim ◽

...

Keyword(s):

Hepatocellular Carcinoma ◽

Hepatitis B ◽

Signal Intensity ◽

Hepatic Tumor ◽

High Signal Intensity ◽

Arterial Phase ◽

High Signal ◽

Hepatic Angiomyolipoma ◽

Phase Images ◽

Hepatitis B Carrier

We report a rare case of resected hepatic AML, which was misdiagnosed as hepatocellular carcinoma in a chronic hepatitis B carrier. A 45-year-old woman who was a carrier of hepatitis B virus infection presented with a hepatic tumor. Her serum alpha-fetoprotein level was normal. Ultrasonography revealed a round and well-circumscribed echogenic hepatic tumor measuring 2.5 cm in the segment VI. On contrast-enhanced computed tomography, a hypervascular tumor was observed in the arterial phase and washing-out of the contrast medium in the portal phase and delayed phase. On MR T1-weighted in-phase images, the mass showed low signal intensity, and on out-of-phase images, the mass showed signal drop and dark signal intensity. On MR T2-weighted images, the mass showed high signal intensity. The mass demonstrated high signal intensity on arterial phase after contrast injection, suggestive of hepatocellular carcinoma. The patient underwent hepatic wedge resection and histopathological diagnosis was a hepatic angiomyolipoma.

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Nodular Hepatocellular Carcinoma: Enhancing Patterns in the Arterial- and Portal-dominant Phases of Spiral CT

Journal of the Korean Radiological Society ◽

10.3348/jkrs.1996.35.2.223 ◽

1996 ◽

Vol 35 (2) ◽

pp. 223

Author(s):

Joon Beom Seo ◽

Byung Ihn Choi ◽

Joon Koo Han ◽

Hak Jong Lee ◽

Jin Wook Chung ◽

...

Keyword(s):

Hepatocellular Carcinoma ◽

Spiral Ct

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A study on the inconsistency of arterial phase hypervascularity detection between contrast-enhanced ultrasound using sonazoid and gadolinium-ethoxybenzyl-diethylenetriamine penta-acetic acid magnetic resonance imaging of hepatocellular carcinoma lesions

Journal of Medical Ultrasonics ◽

10.1007/s10396-021-01086-2 ◽

2021 ◽

Author(s):

Feiqian Wang ◽

Kazushi Numata ◽

Makoto Chuma ◽

Haruo Miwa ◽

Satoshi Moriya ◽

...

Keyword(s):

Magnetic Resonance Imaging ◽

Hepatocellular Carcinoma ◽

Acetic Acid ◽

Magnetic Resonance ◽

Arterial Phase ◽

Contrast Enhanced Ultrasound ◽

Resonance Imaging ◽

Contrast Enhanced

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Differentiation between hepatocellular carcinoma and intrahepatic cholangiocarcinoma using contrast-enhanced ultrasound: A systematic review and meta-analysis

Clinical Hemorheology and Microcirculation ◽

10.3233/ch-211145 ◽

2021 ◽

pp. 1-17

Author(s):

Yanling Chen ◽

Wenping Wang

Keyword(s):

Hepatocellular Carcinoma ◽

Diagnostic Accuracy ◽

Publication Bias ◽

Likelihood Ratio ◽

Intrahepatic Cholangiocarcinoma ◽

Cochrane Library ◽

Arterial Phase ◽

Contrast Enhanced Ultrasound ◽

Diagnostic Ability ◽

Contrast Enhanced

AIM: To explore the diagnostic ability of contrast-enhanced ultrasound (CEUS) in distinguishing intrahepatic cholangiocarcinoma (ICC) from hepatocellular carcinoma (HCC). MATERIALS AND METHODS: PubMed, EMBASE, Cochrane Library, and Web of Science were systematically searched for studies reporting the diagnostic accuracy of CEUS in differentiating ICC from HCC. The diagnostic ability of CEUS was assessed based on the pooled sensitivity, specificity, diagnostic odds ratio (DOR), positive likelihood ratio (PLR), negative likelihood ratio (NLR) and area under the curve (AUC) with 95% confidence intervals (CIs). The methodologic quality was assessed by the QUADAS-2 tool. Subgroup analyses, meta-regression and investigation of publication bias were performed to identify the source of heterogeneity. RESULTS: A total of eight studies were included, consisting of 1,116 patients with HCC and 529 with ICC. The general diagnostic performance of CEUS in distinguishing ICC and HCC were as follows: pooled sensitivity, 0.92 (95% CI: 0.84–0.96); pooled specificity, 0.87 (95% CI: 0.79–0.92); pooled PLR, 7.1 (95% CI: 4.1–12.0); pooled NLR, 0.09 (95% CI: 0.05–0.19); pooled DOR, 76 (95% CI: 26–220) and AUC, 0.95(95% CI: 0.93–0.97). Different liver background may be a potential factor that influenced the diagnostic accuracy of CEUS according to the subgroup analysis, with the pooled DOR of 89.67 in the mixed liver background group and 46.87 in the cirrhosis group, respectively. Six informative CEUS features that may help differentiate HCC from ICC were extracted. The three CEUS features favoring HCC were arterial phase hyperenhancement(APHE), mild washout and late washout (>60s); the three CEUS favoring ICC were arterial rim enhancement, marked washout and early washout(<60s). No potential publication bias was observed. CONCLUSION: CEUS showed great diagnostic ability in differentiating ICC from HCC, which may be promising for noninvasive evaluation of these diseases.

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Hepatic Epithelioid Hemangioendothelioma Presenting Synchronously with Hepatocellular Carcinoma

Case Reports in Gastroenterology ◽

10.1159/000513803 ◽

2021 ◽

pp. 344-351

Author(s):

Hiroki Kanno ◽

Toshihiro Sato ◽

Ryuta Midorikawa ◽

Satoki Kojima ◽

Shogo Fukutomi ◽

...

Keyword(s):

Hepatocellular Carcinoma ◽

Carbohydrate Antigen ◽

Epithelioid Hemangioendothelioma ◽

Arterial Phase ◽

Rapid Progression ◽

Imaging Findings ◽

Liver Segment ◽

Contrast Enhanced ◽

Well Differentiated ◽

Enhanced Computed Tomography

Hepatic epithelioid hemangioendothelioma (EHE) is a rare malignant tumor with unknown pathogenesis. Herein, we report a case of a hepatic EHE presenting synchronously with a hepatocellular carcinoma (HCC). To the best of our knowledge, this is the second case report of synchronous hepatic EHE and HCC. An 84-year-old man presented with back pain. During examination, a tumor in liver segment 3 was coincidentally detected. Tumor marker (carbohydrate antigen 19-9, alpha-fetoprotein, and protein induced by vitamin K absence or antagonist-II) levels were elevated. Contrast-enhanced computed tomography revealed perinodular enhancement in the arterial and portal phases. Another tumor was detected in liver segment 2, which was homogeneously enhanced in the arterial phase, followed by washout in the portal and late phases. Based on these imaging findings, we diagnosed the tumor in segment 3 as a solitary cholangiocellular carcinoma and the tumor in segment 2 as a solitary HCC. Lateral sectionectomy of the liver was performed. Microscopically, spindle-shaped and epithelioid cells were present in the tumor in segment 3. On immunohistochemistry, the tumor cells were positive for CD31 and CD34, focally positive for D2-40, and negative for AE1/AE3. Therefore, the tumor in segment 3 was ultimately diagnosed as an EHE and the tumor in segment 2 as a well-differentiated HCC. Preoperative diagnosis of EHE is difficult owing to the lack of specific findings. Intratumoral calcification, halo sign, and lollipop sign are occasionally found in EHE and are useful imaging findings for diagnosis. Clinical behavior is unpredictable, ranging from indolent growth to rapid progression. Clinical or pathological predictors of the course of EHE are urgently required.

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