Hepatocellular carcinoma: Findings on spiral CT during arterial portography
To determine characteristic imaging features of hepatocellular carcinoma (HCC) on spiral CT during arterial portography (SCTAP) and to correlate the presence or absence of spontaneous portosystemic shunts with the degree of hepatic parenchymal enhancement during SCTAP in patients with HCC.
SCTAP scans of 20 patients with HCC were retrospectively analyzed for tumor features, degree of hepatic parenchymal enhancement, and presence or absence of spontaneous portosystemic shunts.
Nineteen tumors (95%) were hypoattenuating masses and one (5%) was isoattenuating compared with the liver on SCTAP. In seven patients (35%), the tumor was homogeneous in attenuation. Tumor margins were smooth and regular in 12 patients (60%). Vascular invasion and encapsulation were depicted in 10 patients (50%). A high degree of hepatic parenchymal enhancement was observed in 14 patients; one of them (7%) had spontaneous portosystemic shunts. Poor or moderate enhancement was observed in six patients; five of them (83%) had spontaneous portosystemic shunts (p <.001).
The presence of a low attenuated homogeneous intrahepatic mass with associated vascular invasion on SCTAP scans should raise the possibility of HCC. The presence of spontaneous portosystemic shunts is associated with poor or moderate parenchymal enhancement.
Key wordsComputed tomography (CT), helical technology Liver neoplasms, diagnosis Portography Liver neoplasms, CT Hepatocellular carcinoma Portal hypertension
Kojiro M, Nakashima T. Pathology of hepatocellular carcinoma. In: Okuda K, Ishak KG, eds.Neoplasms of the liver.
Tokyo: Springer-Verlag. 1987:81–104Google Scholar
Cooper JN. Imaging and hepatocellular carcinoma.Gastroenterol Clin North Am
Miller WJ, Federle MP, Campbell WL. Diagnosis and staging of hepatocellular carcinoma: comparison of CT and sonography in 36 liver transplantations.AJR
Itai Y, Furui S, Ohtomo K, et al. Dynamic CT features of arterioportal shunts in hepatocellular carcinoma.AJR
Ros PR, Murphy BJ, Buck JL, Olmedilla G, Goodman Z. Encapsulated hepatocellular carcinoma: radiologic findings and pathologic correlation.Gastrointest Radiol
Takayasu K, Moriyama N, Muramatsu Y, et al. The diagnosis of small hepatocellular carcinomas: efficacy of various imaging procedures in 100 patients.AJR
Utsunomiya T, Matsumata T, Adachi E, Honda H, Sugimachi K. Limitations of current preoperative liver imaging techniques for intrahepatic metastatic nodules of hepatocellular carcinoma.Hepatology
Freeny PC, Baron RL, Teefy SA. Hepatocellular carcinoma: reduced frequency of typical findings with dynamic contrast-enhanced CT in a non-Asian population.Radiology
Merine D, Takayasu K, Wakao F. Detection of hepatocellular carcinoma: comparison of CT during arterial portography with CT after intraarterial injection of iodized oil.Radiology
Peterson MS, Baron RL, Dodd III GD, et al. Hepatic parenchymal perfusion defects detected with CTAP: imaging-pathologic correlation.Radiology
Nelson RC, Chezmar JL, Sugarbaker PH, Bernardino ME. Hepatic tumors: comparison of CT during arterial portography, delayed CT, and MR imaging for preoperative evaluation.Radiology
Tyrrel RT, Kaufman SL, Bernardino ME. Straight line sign: appearance and significance during CT portography.Radiology
Heiken JP, Brink JA, Vannier MW. Spiral (helical) CT.Radiology
Zeman RK, Fox SH, Silverman PM, et al. Helical (spiral) CT of the abdomen.AJR
Urban BA, Fishman EK, Kuhlman JE, Kawashima A, Hennessey JG, Siegelman SS. Detection of focal hepatic lesions with spiral CT: comparison of 4- and 8-mm interscan spacing.AJR
Bluemke DA, Fishman EK. Spiral CT arterial portography of the liver.Radiology
Graf O, Dock WI, Lammer J, et al. Determination of optimal time window for liver scanning with CT during arterial portography.Radiology
Paulson EK, Baker ME, Hilleren DJ, et al. CT arterial portography: causes of technical failure and variable liver enhancement.AJR
Soyer P, Lacheheb D, Levesque M. False-positive diagnoses based on CT portography: correlation with pathologic findings.AJR
Okuda K, Musha H, Nakajima J, et al. Clinicopathologic features of encapsulated hepatocellular carcinoma: a study of 26 cases.Cancer
Honda H, Matsuura Y, Onitsuka H, et al. Differential diagnosis of hepatic tumors (hepatoma, hemangioma, and metastasis) with CT: value of two-phase incremental imaging.AJR
Patriquin H, Lafortune M, Burns PN, Dauzat M. Duplex Doppler examination in portal hypertension: technique and anatomy.AJR
Nelson RC, Thompson GH, Chezmar JL, Harned RK II, Fernandez MP. CT during arterial portography: diagnostic pitfalls.RadioGraphics
Soyer P, Lacheheb D, Levesque M. CT arterial portography of the abdomen: effect of injecting papaverine into the mesenteric artery on hepatic contrast enhancement.AJR