Limits...
Early hepatocellular carcinoma: three-phase helical CT features of 16 patients.

Lee J, Lee WJ, Lim HK, Lim JH, Choi N, Park MH, Kim SW, Park CK - Korean J Radiol (2008 Jul-Aug)

Bottom Line: The mosaic pattern was found in only one tumor.Only three (43%) of the seven tumors detected on CT were hyperattenuating during the arterial phase.The four remaining tumors (25%) were hypoattenuating throughout the three phases.

View Article: PubMed Central - PubMed

Affiliation: Department of Radiology and Center of Imaging Science, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea. wjlee@skku.edu

ABSTRACT

Objective: To evaluate the three-phase helical CT features of early hepatocellular carcinomas, based on the new Japanese classification.

Materials and methods: Over the course of an eight-year period, we collected 16 pathologically proven early hepatocellular carcinomas from 16 patients having undergone a three-phase helical CT prior to surgery. The three-phase CT images were acquired at 20-35 sec (arterial phase), 70 sec (portal phase), and 180 sec (equilibrium phase) from the beginning of intravenous injection of contrast material. All the CT images were retrospectively analyzed by two radiologists in consensus, based on their description of morphologic (size, margin, fibrous capsule and mosaic pattern) and enhancement patterns of tumors.

Results: Only seven (44%) of the 16 early hepatocellular carcinomas having undergone a CT were described (mean diameter, 1.2 cm; range, 0.4-2.5 cm). All the tumors had an ill-defined margin with no fibrous capsule. The mosaic pattern was found in only one tumor. Only three (43%) of the seven tumors detected on CT were hyperattenuating during the arterial phase. The four remaining tumors (25%) were hypoattenuating throughout the three phases.

Conclusion: Despite the higher resolution provided by the three phase scans, the contrast-enhanced CT provides only limited detection of the variable morphologic and enhancement features of early hepatocellular carcinomas.

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48-year-old man with early hepatocellular carcinoma of so called "nodule in nodule lesion" (i.e. early advanced hepatocellular carcinoma) located in right hepatic lobe.A. Axial helical CT scan of liver during arterial phase shows 1.8-cm, hypoattenuating nodule with indistinct margin (arrows) located in segment VI of right hepatic lobe. Note faintly enhancing portion (arrowheads) within hypoattenuating nodule, representing mosaic pattern (nodule-in-nodule pattern).B, C. Corresponding portal (B) and equilibrium (C) phase CT scans show same hypoattenuating nodule (arrows). Faintly enhancing portion observed in arterial phase image becomes isoattenuating during later phases.D. Photograph of Hematoxylin and Eosin stained resected specimen shows same nodule (arrows) with indistinct margin and uneven fatty change. Note small nodule (arrowheads) in its upper part (i.e. mosaic pattern - nodule-in-nodule pattern), which corresponds to faintly enhancing portion observed in arterial phase CT image. Histopathologic findings revealed that whole nodule was composed of tumor cells of well-differentiated hepatocellular carcinoma, while small nodule was composed of moderately differentiated hepatocellular carcinoma.
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Figure 2: 48-year-old man with early hepatocellular carcinoma of so called "nodule in nodule lesion" (i.e. early advanced hepatocellular carcinoma) located in right hepatic lobe.A. Axial helical CT scan of liver during arterial phase shows 1.8-cm, hypoattenuating nodule with indistinct margin (arrows) located in segment VI of right hepatic lobe. Note faintly enhancing portion (arrowheads) within hypoattenuating nodule, representing mosaic pattern (nodule-in-nodule pattern).B, C. Corresponding portal (B) and equilibrium (C) phase CT scans show same hypoattenuating nodule (arrows). Faintly enhancing portion observed in arterial phase image becomes isoattenuating during later phases.D. Photograph of Hematoxylin and Eosin stained resected specimen shows same nodule (arrows) with indistinct margin and uneven fatty change. Note small nodule (arrowheads) in its upper part (i.e. mosaic pattern - nodule-in-nodule pattern), which corresponds to faintly enhancing portion observed in arterial phase CT image. Histopathologic findings revealed that whole nodule was composed of tumor cells of well-differentiated hepatocellular carcinoma, while small nodule was composed of moderately differentiated hepatocellular carcinoma.

Mentions: A total of 20 tumors were detected on CT in the 16 patients. Of these patients, ten had one tumor, three had two tumors, and one had four tumors. The two remaining patients underwent a liver transplantation due to liver cirrhosis and showed no tumors on CT, but ultimately were diagnosed with a single early hepatocellular carcinoma from pathologic findings. Of the 10 patients with a single tumor on CT, four had an early hepatocellular carcinoma, whereas the other six had an advanced hepatocellular carcinoma. Of the four patients with multiple tumors on CT, two of the three patients with two hepatocellular carcinomas and the one patient with four hepatocellular carcinomas each had an early hepatocellular carcinoma, whereas the remaining seven tumors were identified as advanced hepatocellular carcinomas. Therefore, only seven (44%) of the 16 early hepatocellular carcinomas were detected on CT. Furthermore, 10 patients showed only one or more advanced hepatocellular carcinoma on CT. Of these seven tumors, five had a maximum diameter between 1 and 2 cm, one was smaller than 1 cm, and one was greater than 2 cm. Therefore, the detection rate was 20% for tumors with maximum diameters smaller than 1 cm, 50% for tumors between 1 and 2 cm, and 100% for tumors greater than 2 cm. All seven of the early hepatocellular carcinomas demonstrated an ill-defined margin with no evidence of a fibrous capsule or fatty metamorphosis on CT. A mosaic pattern was observed in one tumor with a small portion of its composition being identified as having moderately differentiated hepatocellular carcinoma in the background of the well-differentiated hepatocellular carcinoma (Fig. 2).


Early hepatocellular carcinoma: three-phase helical CT features of 16 patients.

Lee J, Lee WJ, Lim HK, Lim JH, Choi N, Park MH, Kim SW, Park CK - Korean J Radiol (2008 Jul-Aug)

48-year-old man with early hepatocellular carcinoma of so called "nodule in nodule lesion" (i.e. early advanced hepatocellular carcinoma) located in right hepatic lobe.A. Axial helical CT scan of liver during arterial phase shows 1.8-cm, hypoattenuating nodule with indistinct margin (arrows) located in segment VI of right hepatic lobe. Note faintly enhancing portion (arrowheads) within hypoattenuating nodule, representing mosaic pattern (nodule-in-nodule pattern).B, C. Corresponding portal (B) and equilibrium (C) phase CT scans show same hypoattenuating nodule (arrows). Faintly enhancing portion observed in arterial phase image becomes isoattenuating during later phases.D. Photograph of Hematoxylin and Eosin stained resected specimen shows same nodule (arrows) with indistinct margin and uneven fatty change. Note small nodule (arrowheads) in its upper part (i.e. mosaic pattern - nodule-in-nodule pattern), which corresponds to faintly enhancing portion observed in arterial phase CT image. Histopathologic findings revealed that whole nodule was composed of tumor cells of well-differentiated hepatocellular carcinoma, while small nodule was composed of moderately differentiated hepatocellular carcinoma.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC2627272&req=5

Figure 2: 48-year-old man with early hepatocellular carcinoma of so called "nodule in nodule lesion" (i.e. early advanced hepatocellular carcinoma) located in right hepatic lobe.A. Axial helical CT scan of liver during arterial phase shows 1.8-cm, hypoattenuating nodule with indistinct margin (arrows) located in segment VI of right hepatic lobe. Note faintly enhancing portion (arrowheads) within hypoattenuating nodule, representing mosaic pattern (nodule-in-nodule pattern).B, C. Corresponding portal (B) and equilibrium (C) phase CT scans show same hypoattenuating nodule (arrows). Faintly enhancing portion observed in arterial phase image becomes isoattenuating during later phases.D. Photograph of Hematoxylin and Eosin stained resected specimen shows same nodule (arrows) with indistinct margin and uneven fatty change. Note small nodule (arrowheads) in its upper part (i.e. mosaic pattern - nodule-in-nodule pattern), which corresponds to faintly enhancing portion observed in arterial phase CT image. Histopathologic findings revealed that whole nodule was composed of tumor cells of well-differentiated hepatocellular carcinoma, while small nodule was composed of moderately differentiated hepatocellular carcinoma.
Mentions: A total of 20 tumors were detected on CT in the 16 patients. Of these patients, ten had one tumor, three had two tumors, and one had four tumors. The two remaining patients underwent a liver transplantation due to liver cirrhosis and showed no tumors on CT, but ultimately were diagnosed with a single early hepatocellular carcinoma from pathologic findings. Of the 10 patients with a single tumor on CT, four had an early hepatocellular carcinoma, whereas the other six had an advanced hepatocellular carcinoma. Of the four patients with multiple tumors on CT, two of the three patients with two hepatocellular carcinomas and the one patient with four hepatocellular carcinomas each had an early hepatocellular carcinoma, whereas the remaining seven tumors were identified as advanced hepatocellular carcinomas. Therefore, only seven (44%) of the 16 early hepatocellular carcinomas were detected on CT. Furthermore, 10 patients showed only one or more advanced hepatocellular carcinoma on CT. Of these seven tumors, five had a maximum diameter between 1 and 2 cm, one was smaller than 1 cm, and one was greater than 2 cm. Therefore, the detection rate was 20% for tumors with maximum diameters smaller than 1 cm, 50% for tumors between 1 and 2 cm, and 100% for tumors greater than 2 cm. All seven of the early hepatocellular carcinomas demonstrated an ill-defined margin with no evidence of a fibrous capsule or fatty metamorphosis on CT. A mosaic pattern was observed in one tumor with a small portion of its composition being identified as having moderately differentiated hepatocellular carcinoma in the background of the well-differentiated hepatocellular carcinoma (Fig. 2).

Bottom Line: The mosaic pattern was found in only one tumor.Only three (43%) of the seven tumors detected on CT were hyperattenuating during the arterial phase.The four remaining tumors (25%) were hypoattenuating throughout the three phases.

View Article: PubMed Central - PubMed

Affiliation: Department of Radiology and Center of Imaging Science, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea. wjlee@skku.edu

ABSTRACT

Objective: To evaluate the three-phase helical CT features of early hepatocellular carcinomas, based on the new Japanese classification.

Materials and methods: Over the course of an eight-year period, we collected 16 pathologically proven early hepatocellular carcinomas from 16 patients having undergone a three-phase helical CT prior to surgery. The three-phase CT images were acquired at 20-35 sec (arterial phase), 70 sec (portal phase), and 180 sec (equilibrium phase) from the beginning of intravenous injection of contrast material. All the CT images were retrospectively analyzed by two radiologists in consensus, based on their description of morphologic (size, margin, fibrous capsule and mosaic pattern) and enhancement patterns of tumors.

Results: Only seven (44%) of the 16 early hepatocellular carcinomas having undergone a CT were described (mean diameter, 1.2 cm; range, 0.4-2.5 cm). All the tumors had an ill-defined margin with no fibrous capsule. The mosaic pattern was found in only one tumor. Only three (43%) of the seven tumors detected on CT were hyperattenuating during the arterial phase. The four remaining tumors (25%) were hypoattenuating throughout the three phases.

Conclusion: Despite the higher resolution provided by the three phase scans, the contrast-enhanced CT provides only limited detection of the variable morphologic and enhancement features of early hepatocellular carcinomas.

Show MeSH
Related in: MedlinePlus