Aims and objectives
Hepatocellular carcinoma (HCC)is second most common cause for cancer related deaths worldwide.1,2 HCC can be diagnosed non-invasivelyby theircharacteristic enhancement features on contrast enhanced dynamic computed tomography (CT) or magnetic resonance imaging (MRI) according to EASL,
AASLD and LIRADs criteria3.
Non-alcoholic fatty liver disease (NAFLD) is the most common cause of chronic liver disease in both Europe and USA and linked to epidemic of obesity and metabolic syndrome.3,4NAFLD can progress to non-alcoholic steatohepatitis (NASH) which can then progress to cirrhosis and its assoicated complications including development...
Methods and materials
This is an institutional review board (IRB) approved,
HIPPA-compliant retrospective study with waiver of informed consent.
Patient selection:
We reviewed our institutional pathology and imaging database between January 2006 and December 2016 for patients with HCC and hepatic steatosis.
Inclusion criteria:
HCC confirmed on pathology.
Hepatic steatosis confirmed on pathology or at MRI (hepatic fat signal fraction >5%) performed within 6 months of HCC confirmation
Triphasic CT obtained within 6 months of pathologic confirmation.
Exclusion criteria:
Percutaneous or interventional locoregional treatment prior to triphasic CT....
Results
Clinical characteristics:
Mean age
63.3 years (range 43-80).
Gender
Female,
number (%)
Male,
number (%)
14 (33.3)
28 (66.7)
BMI (mean ± SD),
kg/m2
31.4±8.5
Obesity,
number (%)
25 (59.5)
Diabetes,
number (%)
28 (66.7)
Total Cholesterol (mean ± SD),
mg/dL
153±41 (range: 36 to 229)
Triglycerides (mean ± SD),
mg/dL
136±53 (range: 54 to 237)
Histology findings:
Tumor Size (mean±SD)
4.3±3.0 cm
Tumor Grade
Well
Well-Moderate
Moderate
Moderately-Poor
Poor
Number (%)
15 (35.7)
5 (11.9)
17 (40.5)
2 (4.8)
3 (7.1)
Hepatic Steatosis Grade...
Conclusion
HCCs in NAFLD on CT
A significant proportion occur innon-cirrhotic liver
May not demonstrate major features defined in EASL especially washout.
Delayed phase imaging important for assessment of washout in these patients
Inter-reader agreement is fair to very goof for major HCC features except for capsule
The lack of washout may be relatedto the hepatic steatosis in the backgroundliver parenchyma and mildto moderate degree of fibrosis.
This reuslts in an hyperenhanced appearance of the HCC.
There is a need for modification of criteria for CT...
Personal information
This work was performed at Departments of Radiology and Pathology,
Mayo Clinic,
Mayo Clinic College of Medicine,
Rochester,
Minnesota,
USA
Ishan Garg,
MBBS- Research Trainee
Scott M.
Thompson,MD- Radiology Resident
Eric C.
Ehman,
MD-Abdominal RadiologyFellow
Shannon P.
Sheedy,
MD- ConsultantAbdominal Radiologist
Ashish Khandelwal,
MD- ConsultantAbdominal Radiologist
Candice A.
Bookwalter,
MD- ConsultantAbdominal Radiologist
Taofic Mounajjed,
MD - Consultant Hepatobiliary Pathologist
Sudhakar K.
Venkatesh,
MD- ConsultantAbdominal Radiologist
Comments and questions to
[email protected]
References
Perumpail RB,
Wong RJ,
Ahmed A,
et al (2015) Hepatocellular Carcinoma in the Setting of Non-cirrhotic Nonalcoholic Fatty Liver Disease and the Metabolic Syndrome: US Experience.
Dig Dis Sci.
60(10):3142-8.
Ford ES,
Giles WH,
Mokdad AH (2004) Increasing prevalence of the metabolic syndrome among U.S.
adults.
Diabetes Care.
27(10):2444-9.
Flegal KM,
Carroll MD,
Ogden CL,
Curtin LR (2010) Prevalence and trends in obesity among US adults,
1999–2008.
JAMA.
303(3):235-41.
Torres DM,
Williams CD,
Harrison SA (2012) Features,
diagnosis,
and treatment of nonalcoholic fatty liver disease....