Learning objectives
To depicture imaging characteristics of diffuse hepatocarcinoma with special focus in MR.
To assess differential diagnoses especially with other subtypes of HCC.
Background
Hepatocellular Carcinoma (HCC) is the sixth most common cancer worldwide and the third cause of cancer related death.
HCC most commonly arises in the background of chronic liver disease (cirrhosis).
Imaging findings of the morphological subtypes “focal/nodular” of HCC are widely described.
Diffuse subtype accounts for almost 13% of the total amount of the disease and it’s often diagnosed at advanced stage and so it has worse prognosis because therapeutic options are limited.
Diffuse HCC detection can be a challenge due to its subtle image...
Imaging findings OR Procedure details
We reviewed 17 patients who had at least one hepatic DCE-MRI and who were diagnosed as diffuse HCC.
A 1.5 tesla MRI was used to perfom exams.
Standard Liver MRI protocol in our institution is detailed in Table 1.
US FINDINGS
14 patients had a previous US liver study performed.
None of them were diagnosed,
but in 2 of them diffuse hepatocellular carcinoma were suggested due to portal vein thrombosis (Fig. 1)(Fig. 2).
Metastasis or classic HCC was reported in 7 patients and no suspicious...
Conclusion
Surveillance in cirrhotic patients must look carefully for radiological features of diffuse HCC.
Malignant portal thrombosis,
restriction in DWI and abnormal diffuse findings in DCE-MRI must alert the radiologist.
Unfortunately,
diagnosis of HCC diffuse is related to ominous prognosis regardless actual treatments.
References
1.
Demirjian A,
Peng P,
Geschwind JF,
Cosgrove D,
SchutzKamel I,
Pawlik T . Infiltrating hepatocellular carcinoma: Seeing the tree through the forest.
J Gastrointestinal Surgery 2011; 15: 2089-2097.
2.
Haliloglu N,
Özkavukcu E,
Erden A,
Enden I.
MR imaging in diffuse-typr hepatocellular carcinoma with synchronous portal vein thrombi.
Turk Journal of Gastroenterol 2011; 22 (2): 158-164.
3.
Shah Z,
McKernan M,
Hahn P,
Sahany D.
Enhancing and expansile portal vein thrombosis: Value in the diagnosis of hepatocellular carcinoma in patients with multiple hepatic lesions....