Learning objectives
To make a comprehensive review of the spectrum of hepatic nodules in cirrhotic patients using multidetector computed tomography (MDCT) scan and magnetic resonance (MR).
To outline what imaging features can help radiologists to find the correct diagnosis when facing a hepatic nodule in a patient with chronic liver disease.
Background
The incidence of hepatocellular carcinoma (HCC) is increasing worldwide.
Currently it is the third leading cause of death from cancer and the first leading cause of death in patients with liver cirrhosis.
[1]
90% of HCC in the western world arises in a cirrhotic background and one-third of cirrhotic patients will develop HCC during their lifetime.
[2]
To reduce the disease-related mortality an early diagnosis allowing the application of curative therapies is essential.
Accordingly to the 2012 consensus guidelines from the European Association for the...
Imaging findings OR Procedure details
MR Protocol usually includes unenhanced imaging T1 gradient-recalled echo (GRE) sequences with out-of-phase and in-phase image acquisitions,
T1 with fat-saturation,
T2 with fat-saturation,
and sometimes T2*.
In some centers,
diffusion-weighted sequences are also performed.
After administration of the gadolinium chelate T1-weighted images are acquired in arterial,
portal and late phases.
Some centers also recommend mixed extracellular and hepatocellular agents and Superparamagnetic iron oxide based MRI contrast agents but until now dynamic MRI after bolus injection of gadolinium is still the workhorse of liver imaging.
MDCT...
Conclusion
MDCT and MR are of great value in characterization of nodular lesions in cirrhotic patients.
Particularly MR is able to depict some chemical components of the lesions besides the morphological data.
Besides the established HCC radiological hallmark (contrast uptake in the arterial phase and washout in the venous/late phase) there are several imaging features associated with HCC and its precursors.
Familiarity with MDCT and MR evaluation of cirrhosis-associated hepatocellular nodules is fundamental to assure an adequate decision-making process of these patients,
even though the exact...
References
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Estimates of worldwide burden of cancer in 2008: GLOBOCAN 2008 Int J Cancer 2010; 127: 2893-917
EASL–EORTC Clinical Practice Guidelines: Management of hepatocellular carcinoma.
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Bruix J,
Sherman M.
Management of hepatocellular carcinoma.
Hepatology 2005;42:1208–1236.
Bruix J,
Sherman M.
Management of hepatocellular carcinoma: an update.
Hepatology 2011;53:1020–1022.
Hanna RF et al,
Cirrhosis-associated Hepatocellular Nodules: Correlation of Histopathologic and MR Imaging Features,
RadioGraphics 2008;28:747-770.
Hussain SM,
Zondervan PE,
IJzermans JN,
Schalm SW,
de Man...