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European Radiology

, Volume 29, Issue 12, pp 6539–6549 | Cite as

Analysis of Lipiodol uptake in angiography and computed tomography for the diagnosis of malignant versus benign hepatocellular nodules in cirrhotic liver

  • Marcel C. LangenbachEmail author
  • Thomas J. Vogl
  • Isabelle von den Driesch
  • Benjamin Kaltenbach
  • Jan-Erik Scholtz
  • Renate M. Hammerstingl
  • Tatjana Gruber-Rouh
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  • 67 Downloads

Abstract

Objectives

To evaluate the diagnostic value of Lipiodol distribution in angiography and CT to differentiate between hepatocellular carcinoma (HCC) and benign nodules of LI-RADS 3 and 4 lesions observed in MRI of liver cirrhosis.

Methods

This retrospective study included all patients with liver cirrhosis who had diagnosis of LI-RADS 3 or 4 lesions by MRI who underwent a Lipiodol-based angiography and post-interventional unenhanced CT- and liver biopsy. Two independent radiologists evaluated appearance, contrast enhancement, Lipiodol uptake in angiography, and morphological parameters (size, form, and density) of the lesions in unenhanced post-angiography CT. α-Fetoprotein (AFP) levels and pre-existing liver conditions were additionally taken into consideration. Differences between HCC lesions and benign nodules were analyzed. Sensitivity and specificity were calculated. P < 0.05 was considered as statistically significant.

Results

Of 60 patients (men, n = 42 [70.0%]; women, 18 [30.0%]; mean age, 61 ± 9.1 years) 36 (60.0%) had HCC and 24 (40.0%) benign nodules. Clear visibility in angiography (sensitivity [se], 100%; specificity [sp], 87.5%) with homogeneous or lacunar Lipiodol enhancement (se, 86.1%; sp, 100%) in consecutive CT can be diagnosed as HCC lesions in cirrhotic liver. Lesion form (p < 0.001), round or oval, and intense contrast (p < 0.001) are minor features which can facilitate the findings. Furthermore, patients with HCC showed a larger lesion size in CT (p = 0.026).

Conclusion

Clearly detectable lesions in Lipiodol-based angiography and a homogeneous or lacunar enhancement in post-angiographic non-contrast CT allow for differentiation of intrahepatic lesions classified as LI-RADS 3 or 4 into benign vs. malign liver lesions with high sensitivity and specificity in patients with liver cirrhosis. Definite diagnosis may not require an additional biopsy.

Key Points

Combination of clear visibility in Lipiodol-based angiography and homogeneous or lacunar enhancement in following native CT scan is HCC-defining.

In lesions classified with MRI as LI-RADS 3 or 4, evaluation based on Lipiodol angiography and following plain CT performed is highly sensitive and specific for the differentiation between HCC and benign nodules in a cirrhotic liver.

The results lead to an alternative pathway in the diagnosis of HCC in cirrhotic liver without the need of an additional liver biopsy.

Keywords

Ethiodized oil Carcinoma, hepatocellular Angiography Tomography, X-ray computed Liver cirrhosis 

Abbreviations

ADC

Apparent diffusion coefficient

AFP

α-FetoProtein

BCLC

Barcelona Clinic Liver Cancer

CT

Computed tomography

cTACE

Conventional transarterial chemoembolization

HCC

Hepatocellular carcinoma

IRV

Inter-reader variability

LI-RADS

Liver Imaging Reporting and Data System

MRI

Magnetic resonance imaging

TAE

Transarterial embolization

Notes

Funding

This study has received funding by Guerbet GmbH.

Compliance with ethical standards

Guarantor

The scientific guarantor of this publication is Marcel C. Langenbach.

Conflict of interest

All authors of this manuscript declare no relationships with any companies whose products or services may be related to the subject matter of the article.

Statistics and biometry

One of the authors has significant statistical expertise.

Informed consent

Written informed consent was waived by the Institutional Review Board.

Ethical approval

Institutional Review Board approval was obtained.

Methodology

• Retrospective

• Diagnostic or prognostic study

• Performed at one institution

References

  1. 1.
    Li JP, Feng GL, Li DQ et al (2016) Detection and differentiation of early hepatocellular carcinoma from cirrhosis using CT perfusion in a rat liver model. Hepatobiliary Pancreat Dis Int 15:612–618CrossRefGoogle Scholar
  2. 2.
    Li JJ, Zheng JS, Cui SC et al (2015) C-arm Lipiodol CT in transcatheter arterial chemoembolization for small hepatocellular carcinoma. World J Gastroenterol 21:3035–3040.  https://doi.org/10.3748/wjg.v21.i10.3035 CrossRefPubMedPubMedCentralGoogle Scholar
  3. 3.
    Song DS, Bae SH (2012) Changes of guidelines diagnosing hepatocellular carcinoma during the last ten-year period. Clin Mol Hepatol 18:258–267.  https://doi.org/10.3350/cmh.2012.18.3.258 CrossRefPubMedPubMedCentralGoogle Scholar
  4. 4.
    Piana G, Trinquart L, Meskine N, Barrau V, Beers BV, Vilgrain V (2011) New MR imaging criteria with a diffusion-weighted sequence for the diagnosis of hepatocellular carcinoma in chronic liver diseases. J Hepatol 55:126–132.  https://doi.org/10.1016/j.jhep.2010.10.023
  5. 5.
    Forner A, Vilana R, Ayuso C et al (2008) Diagnosis of hepatic nodules 20 mm or smaller in cirrhosis: prospective validation of the noninvasive diagnostic criteria for hepatocellular carcinoma. Hepatology 47:97–104.  https://doi.org/10.1002/hep.21966 CrossRefPubMedGoogle Scholar
  6. 6.
    Pesapane F, Nezami N, Patella F, Geschwind JF (2017) New concepts in embolotherapy of HCC. Med Oncol 34:58.  https://doi.org/10.1007/s12032-017-0917-2 CrossRefPubMedGoogle Scholar
  7. 7.
    Woo HY, Heo J (2015) Transarterial chemoembolization using drug eluting beads for the treatment of hepatocellular carcinoma: now and future. Clin Mol Hepatol 21:344–348.  https://doi.org/10.3350/cmh.2015.21.4.344 CrossRefPubMedPubMedCentralGoogle Scholar
  8. 8.
    Landis JR, Koch GG (1977) The measurement of observer agreement for categorical data. Biometrics 33:159–174.  https://doi.org/10.2307/2529310 CrossRefPubMedPubMedCentralGoogle Scholar
  9. 9.
    de Baere T, Arai Y, Lencioni R et al (2016) Treatment of liver tumors with Lipiodol TACE: technical recommendations from experts opinion. Cardiovasc Intervent Radiol 39:334–343.  https://doi.org/10.1007/s00270-015-1208-y CrossRefPubMedGoogle Scholar
  10. 10.
    Takayasu K, Arii S, Matsuo N et al (2000) Comparison of CT findings with resected specimens after chemoembolization with iodized oil for hepatocellular carcinoma. AJR Am J Roentgenol 175:699–704.  https://doi.org/10.2214/ajr.175.3.1750699 CrossRefPubMedGoogle Scholar
  11. 11.
    Hino T, Kawashima Y, Shimabayashi S (2000) Basic study for stabilization of w/o/w emulsion and its application to transcatheter arterial embolization therapy. Adv Drug Deliv Rev 45:27–45CrossRefGoogle Scholar
  12. 12.
    Idée JM, Guiu B (2013) Use of Lipiodol as a drug-delivery system for transcatheter arterial chemoembolization of hepatocellular carcinoma: a review. Crit Rev Oncol Hematol 88:530–549.  https://doi.org/10.1016/j.critrevonc.2013.07.003 CrossRefPubMedGoogle Scholar
  13. 13.
    Zheng J, Li J, Cui X, Ye H, Ye L (2013) Comparison of diagnostic sensitivity of C-arm CT, DSA and CT in detecting small HCC. Hepatogastroenterology 60:1509–1512.  https://doi.org/10.5754/hge121220
  14. 14.
    Kondo S, Takagi K, Nishida M et al (2017) Computer-aided diagnosis of focal liver lesions using contrast-enhanced ultrasonography with perflubutane microbubbles. IEEE Trans Med Imaging 36:1427–1437.  https://doi.org/10.1109/TMI.2017.2659734 CrossRefPubMedGoogle Scholar
  15. 15.
    Martins-Filho SN, Paiva C, Azevedo RS, Alves VAF (2017) Histological grading of hepatocellular carcinoma—a systematic review of literature. Front Med (Lausanne) 4.  https://doi.org/10.3389/fmed.2017.00193
  16. 16.
    Llovet JM, Paradis V, Kudo M, Zucman-Rossi J (2011) Tissue biomarkers as predictors of outcome and selection of transplant candidates with hepatocellular carcinoma. Liver Transpl 17(Suppl 2):S67–S71.  https://doi.org/10.1002/lt.22340 CrossRefPubMedPubMedCentralGoogle Scholar
  17. 17.
    Kim H, Choi GH, Na DC et al (2011) Human hepatocellular carcinomas with “Stemness”-related marker expression: keratin 19 expression and a poor prognosis. Hepatology 54:1707–1717.  https://doi.org/10.1002/hep.24559 CrossRefPubMedGoogle Scholar

Copyright information

© European Society of Radiology 2019

Authors and Affiliations

  1. 1.Institute for Diagnostic and Interventional RadiologyUniversity Hospital FrankfurtFrankfurtGermany

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