Aims and objectives
A small arterial enhancing lesion with isoattenuation on portal venous phase or delayed phase (a so-called small arterial enhancing lesion) in patients with chronic liver disease presents diagnostic dilemma because the differential diagnosis includes small hepatocellular carcinoma (HCC) with atypical vascular pattern as well as benign hypervascular lesion,
such as non-tumorous arterioportal (AP) shunt [1-4].
Most of the small arterial enhancing lesions are usuallyfurther evaluated with follow-up computed tomography (CT),
magnetic resonance imaging (MRI) or core needle biopsy.
However,
earlier detection of atypical and small...
Methods and materials
Study population
Fig. 1is a flowchart that summarizes the inclusion process in this study.
[6-10].
The final cohort included 23 patients with 28 HCCs and 25 patients with 28 AP shunts (5 – 20mm).
Five patients with HCCs and 3 patients with AP shunts had two lesions each.
CT technique
All patients underwent quadriphasic liver CT,
including precontrast phase,
arterial phase,
portal venous phase,
delayed phase images.
Image analysis
1.
Qualitative and quantitative analysis
1) Morphologic features [1]
- Size: the longest dimension on axial...
Results
1.
Qualitative and quantitative analysis
The result of univariate and multivariate analysisfor the predictive variables of HCCare summarized inTable 2.
2.
Evaluation of the added value of precontrast phase for differentiating small HCC from AP shunt
Table 3shows the diagnostic predictive values for both observers of each reading session.
Additional interpretation of precontrast phase enabled the two observers to correct several diagnostic errors made on the review of triphasic CT (Fig. 2).
- Eleven cases were overdiagnosed on triphasic CT by both observers,
and all...
Conclusion
1.
Previous studies that have evaluated the additional role of precontrast phase in the detection of HCC
Some investigators found no merit of adding precontrast phase [12,
13].
However,
Oliver et al.
[14] reported that the additional review of precontrast phasewith portal venous phase images led to detection of 16 – 18 % additional lesions,
which were not identified on the portal venous images.
Kim et al.
[15] have also demonstrated that the addition of precontrast phase to the biphasic CT increased the detection and...
References
1.Park MJ,
Kim YS,
Lee WJ,
Lim HK,
Rhim H,
Lee J (2010) Outcomes of follow-up CT for small (5-10-mm) arterially enhancing nodules in the liver and risk factors for developing hepatocellular carcinoma in a surveillance population.
Eur Radiol 20:2397-2404
2.Quaia E,
Pizzolato R,
De Paoli L,
Angileri R,
Ukmar M,
Cova MA (2013) Arterial enhancing-only nodules less than 2 cm in diameter in patients with liver cirrhosis: predictors of hepatocellular carcinoma diagnosis on gadobenate dimeglumine-enhanced MR imaging.
J Magn Reson Imaging 37:892-902
3.Hwang SH,...