Limits...
Imaging and Imaging-Guided Interventions in the Diagnosis and Management of Hepatocellular Carcinoma (HCC)-Review of Evidence.

Ghanaati H, Alavian SM, Jafarian A, Ebrahimi Daryani N, Nassiri-Toosi M, Jalali AH, Shakiba M - Iran J Radiol (2012)

Bottom Line: A variety of imaging modalities, such as ultrasound, computed tomography (CT), magnetic resonance imaging (MRI) and nuclear medicine are currently used in evaluating patients with HCC.Although the best option for the treatment of these cases is hepatic resection or transplantation, only 20% of HCCs are surgically treatable.In those patients who are not eligible for surgical treatment, interventional therapies such as transcatheter arterial chemoembolization (TACE), percutaneous ethanol injection (PEI), radio-frequency ablation (RFA), percutaneous microwave coagulation therapy (PMC), laser ablation or cryoablation, and acetic acid injection are indicated.

View Article: PubMed Central - PubMed

Affiliation: Department of Radiology, Faculty of Medicine, Tehran University of Medical Sciences, Tehran, Iran ; Advanced Diagnostic and Interventional Radiology Research Center (ADIR), Tehran University of Medical Sciences, Tehran, Iran.

ABSTRACT
The imaging of hepatocellular carcinoma (HCC) is challenging and plays a crucial role in the diagnosis and staging of the disease. A variety of imaging modalities, such as ultrasound, computed tomography (CT), magnetic resonance imaging (MRI) and nuclear medicine are currently used in evaluating patients with HCC. Although the best option for the treatment of these cases is hepatic resection or transplantation, only 20% of HCCs are surgically treatable. In those patients who are not eligible for surgical treatment, interventional therapies such as transcatheter arterial chemoembolization (TACE), percutaneous ethanol injection (PEI), radio-frequency ablation (RFA), percutaneous microwave coagulation therapy (PMC), laser ablation or cryoablation, and acetic acid injection are indicated. In this paper, we aimed to review the evidence regarding imaging modalities and therapeutic interventions of HCC.

No MeSH data available.


Related in: MedlinePlus

MRI in HCCA, Axial T2-W image shows heterogeneous high signal area, pseudocapsule and central hyposignal area in favor of necrosis; B, T1-W image after gadolinium injection shows enhancement of the mentioned mass in the left lobe; C, Axial T1-W shows hyposignal mass in the left lobe.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
getmorefigures.php?uid=PMC3569547&req=5

fig753: MRI in HCCA, Axial T2-W image shows heterogeneous high signal area, pseudocapsule and central hyposignal area in favor of necrosis; B, T1-W image after gadolinium injection shows enhancement of the mentioned mass in the left lobe; C, Axial T1-W shows hyposignal mass in the left lobe.

Mentions: MRI should be performed in patients who have non-diagnostic findings on CT or patients in whom iodinated contrast agents are contraindicated (Figure 3).MRI is superior to CT in T2 hyperintense malignant lesions and the sensitivity of dynamic contrast-enhanced MRI is more than dynamic contrast-enhanced CT (84% vs. 47%); also MRI can depict smaller lesions (1-2 cm in diameter) in comparison with CT (20). MR shows better efficacy in comparison to CT on decision making for the management of patients (90% vs. 77-80% for decision making) (35, 36). HCC patients show variable signal intensity on T1-weighted images and most of them have mild hyperintense signals on T2-weighted sequences. Contrast enhancement is useful in the detection of most HCCs in the arterial phase and well-timed arterial phase imaging is essential for depiction and characterization of HCCs during dynamic MRI. MRI is also beneficial in T2 hypointense nodules smaller than 1 cm in size and also T2 hypointense dysplastic nodules greater than 1 cm (37). Although regenerative nodules have variable signal intensity on T1 weighted images, they are usually iso-intense in this sequence; while on T2-weighted images, they have low signal intensity.The use of contrast agents such as super paramagnetic iron oxide particles and gadobenate dimeglumine may increase the sensitivity and specificity of MRI in the detection of HCC (38). For those patients who are undergoing staging studies using liver specific MRI contrast agents, a dynamic scan with gadolinium chelates can be done immediately afterwards with a second injection, which results in a dual contrast MRI study (39). Diffusion-weighted image (DWI) is a non-invasive quantification of water diffusion and microcapillary blood perfusion without gadolinium contrast material, which is especially important in those cases with renal dysfunction at risk for nephrogenic systemic fibrosis (40). Using DWI we can increase the detection rate of focal liver lesions and HCC with gadolinium-enhanced MR in cirrhotic patients (41). Another application of DWI is treatment monitoring after chemotherapy or chemoembolization in HCC and other liver tumors (42). Cellular necrosis causes increased membranous permeability and subsequently free diffusion of water molecules and finally increase in the ADC value that enables early detection of cellular necrosis (42). Magnetic resonance elastography (MRE) is a non-invasive quantitative technique for evaluation of mechanical properties of the tissue. This technique is useful in quantitative tissue characterization for differentiating benign and malignant liver tumors (9).


Imaging and Imaging-Guided Interventions in the Diagnosis and Management of Hepatocellular Carcinoma (HCC)-Review of Evidence.

Ghanaati H, Alavian SM, Jafarian A, Ebrahimi Daryani N, Nassiri-Toosi M, Jalali AH, Shakiba M - Iran J Radiol (2012)

MRI in HCCA, Axial T2-W image shows heterogeneous high signal area, pseudocapsule and central hyposignal area in favor of necrosis; B, T1-W image after gadolinium injection shows enhancement of the mentioned mass in the left lobe; C, Axial T1-W shows hyposignal mass in the left lobe.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC3569547&req=5

fig753: MRI in HCCA, Axial T2-W image shows heterogeneous high signal area, pseudocapsule and central hyposignal area in favor of necrosis; B, T1-W image after gadolinium injection shows enhancement of the mentioned mass in the left lobe; C, Axial T1-W shows hyposignal mass in the left lobe.
Mentions: MRI should be performed in patients who have non-diagnostic findings on CT or patients in whom iodinated contrast agents are contraindicated (Figure 3).MRI is superior to CT in T2 hyperintense malignant lesions and the sensitivity of dynamic contrast-enhanced MRI is more than dynamic contrast-enhanced CT (84% vs. 47%); also MRI can depict smaller lesions (1-2 cm in diameter) in comparison with CT (20). MR shows better efficacy in comparison to CT on decision making for the management of patients (90% vs. 77-80% for decision making) (35, 36). HCC patients show variable signal intensity on T1-weighted images and most of them have mild hyperintense signals on T2-weighted sequences. Contrast enhancement is useful in the detection of most HCCs in the arterial phase and well-timed arterial phase imaging is essential for depiction and characterization of HCCs during dynamic MRI. MRI is also beneficial in T2 hypointense nodules smaller than 1 cm in size and also T2 hypointense dysplastic nodules greater than 1 cm (37). Although regenerative nodules have variable signal intensity on T1 weighted images, they are usually iso-intense in this sequence; while on T2-weighted images, they have low signal intensity.The use of contrast agents such as super paramagnetic iron oxide particles and gadobenate dimeglumine may increase the sensitivity and specificity of MRI in the detection of HCC (38). For those patients who are undergoing staging studies using liver specific MRI contrast agents, a dynamic scan with gadolinium chelates can be done immediately afterwards with a second injection, which results in a dual contrast MRI study (39). Diffusion-weighted image (DWI) is a non-invasive quantification of water diffusion and microcapillary blood perfusion without gadolinium contrast material, which is especially important in those cases with renal dysfunction at risk for nephrogenic systemic fibrosis (40). Using DWI we can increase the detection rate of focal liver lesions and HCC with gadolinium-enhanced MR in cirrhotic patients (41). Another application of DWI is treatment monitoring after chemotherapy or chemoembolization in HCC and other liver tumors (42). Cellular necrosis causes increased membranous permeability and subsequently free diffusion of water molecules and finally increase in the ADC value that enables early detection of cellular necrosis (42). Magnetic resonance elastography (MRE) is a non-invasive quantitative technique for evaluation of mechanical properties of the tissue. This technique is useful in quantitative tissue characterization for differentiating benign and malignant liver tumors (9).

Bottom Line: A variety of imaging modalities, such as ultrasound, computed tomography (CT), magnetic resonance imaging (MRI) and nuclear medicine are currently used in evaluating patients with HCC.Although the best option for the treatment of these cases is hepatic resection or transplantation, only 20% of HCCs are surgically treatable.In those patients who are not eligible for surgical treatment, interventional therapies such as transcatheter arterial chemoembolization (TACE), percutaneous ethanol injection (PEI), radio-frequency ablation (RFA), percutaneous microwave coagulation therapy (PMC), laser ablation or cryoablation, and acetic acid injection are indicated.

View Article: PubMed Central - PubMed

Affiliation: Department of Radiology, Faculty of Medicine, Tehran University of Medical Sciences, Tehran, Iran ; Advanced Diagnostic and Interventional Radiology Research Center (ADIR), Tehran University of Medical Sciences, Tehran, Iran.

ABSTRACT
The imaging of hepatocellular carcinoma (HCC) is challenging and plays a crucial role in the diagnosis and staging of the disease. A variety of imaging modalities, such as ultrasound, computed tomography (CT), magnetic resonance imaging (MRI) and nuclear medicine are currently used in evaluating patients with HCC. Although the best option for the treatment of these cases is hepatic resection or transplantation, only 20% of HCCs are surgically treatable. In those patients who are not eligible for surgical treatment, interventional therapies such as transcatheter arterial chemoembolization (TACE), percutaneous ethanol injection (PEI), radio-frequency ablation (RFA), percutaneous microwave coagulation therapy (PMC), laser ablation or cryoablation, and acetic acid injection are indicated. In this paper, we aimed to review the evidence regarding imaging modalities and therapeutic interventions of HCC.

No MeSH data available.


Related in: MedlinePlus