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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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Related in: MedlinePlus

54-year-old man with early hepatocellular carcinoma located in right hepatic lobe.A. Three-phase helical CT image obtained during arterial phase shows 0.8cm, faintly hyperattenuating nodule with indistinct margin (arrows) in segment VI of right hepatic lobe.B, C. Corresponding portal (B) and equilibrium (C) phase CT scans show that hyperattenuating nodule observed in arterial phase becomes isoattenuating during portal and equilibrium phases (arrows).
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Figure 3: 54-year-old man with early hepatocellular carcinoma located in right hepatic lobe.A. Three-phase helical CT image obtained during arterial phase shows 0.8cm, faintly hyperattenuating nodule with indistinct margin (arrows) in segment VI of right hepatic lobe.B, C. Corresponding portal (B) and equilibrium (C) phase CT scans show that hyperattenuating nodule observed in arterial phase becomes isoattenuating during portal and equilibrium phases (arrows).

Mentions: The enhancement patterns of all the early hepatocellular carcinomas are tabulated in Table 1. The nine tumors which were not detected by CT were regarded as being isoattenuating throughout all three phases (i.e. iso-iso-iso). Of the seven tumors that were detected by CT, only three (43%) appeared to be faintly hyperattenuating during the arterial phase, and subsequently became isoattenuating in one patient (high-iso-iso), and hypoattenuating in two patients (high-high-low and high-low-low) during the equilibrium phase (Fig. 3). The four remaining tumors were hypoattenuating throughout all three CT phases (low-low-low). Moreover, these four tumors were histologically revealed as having fatty metamorphosis ranging from 20 to 50% (Fig. 4). Therefore, of the 16 tumors, attenuation during the arterial phase was hyperattenuating, isoattenuating, and hypoattenuating in 19%, 56%, and 25%, respectively.


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)

54-year-old man with early hepatocellular carcinoma located in right hepatic lobe.A. Three-phase helical CT image obtained during arterial phase shows 0.8cm, faintly hyperattenuating nodule with indistinct margin (arrows) in segment VI of right hepatic lobe.B, C. Corresponding portal (B) and equilibrium (C) phase CT scans show that hyperattenuating nodule observed in arterial phase becomes isoattenuating during portal and equilibrium phases (arrows).
© Copyright Policy - open-access
Related In: Results  -  Collection

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

Figure 3: 54-year-old man with early hepatocellular carcinoma located in right hepatic lobe.A. Three-phase helical CT image obtained during arterial phase shows 0.8cm, faintly hyperattenuating nodule with indistinct margin (arrows) in segment VI of right hepatic lobe.B, C. Corresponding portal (B) and equilibrium (C) phase CT scans show that hyperattenuating nodule observed in arterial phase becomes isoattenuating during portal and equilibrium phases (arrows).
Mentions: The enhancement patterns of all the early hepatocellular carcinomas are tabulated in Table 1. The nine tumors which were not detected by CT were regarded as being isoattenuating throughout all three phases (i.e. iso-iso-iso). Of the seven tumors that were detected by CT, only three (43%) appeared to be faintly hyperattenuating during the arterial phase, and subsequently became isoattenuating in one patient (high-iso-iso), and hypoattenuating in two patients (high-high-low and high-low-low) during the equilibrium phase (Fig. 3). The four remaining tumors were hypoattenuating throughout all three CT phases (low-low-low). Moreover, these four tumors were histologically revealed as having fatty metamorphosis ranging from 20 to 50% (Fig. 4). Therefore, of the 16 tumors, attenuation during the arterial phase was hyperattenuating, isoattenuating, and hypoattenuating in 19%, 56%, and 25%, respectively.

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