Learning objectives
1.To present and illustrate the main hypervascular non-tumoral and tumoral entities in a cirrhotic liver.
2.To differentiate hepatocellular carcinoma from other benign and malignant tumoral entities.
Background
Cirrhosis is an advanced chronic liver disease with a wide clinical and pathophysiologic spectrum resulting from repetitive liver injury.
Hepatocellular carcinoma (HCC) is the most frequent malignant tumoral entity which may form in a cirrhotic liver, and it’s often diagnosed based on it’s imagistic appearance (CT and MRI semiology).
Hepatocarcinogenesis. At a molecular level hepatocarcinogenesis is always involving multiple alterations until the normal hepatocyte is transformed into a malignant cell Fig. 1 , meanwhile at a histological level, hepatocarcinogenesis may be multistep as before mentioned...
Findings and procedure details
A retrospective study of 10 years including 100 pacients with liver cirrhosis aged 45-80 years underwent abdominal CT and MRI without and with iv contrast injection.
This review illustrates MRI and CT aspects of different benign and malignant hypervascular lesions using protocols as we’ll list bellow.
CT and MRI TECHNIQUE
Multislice CT protocol:
-non-enhanced multi-slice CT;
- contrast enhanced multi-slice CT after injection of 1,5 ml/kc of nonionic iodine based contrast media with a power injector flow of 3,5 mL/s, bolus triger/ROI in the abdominal...
Conclusion
A wide spectrum of benign and malignant lesions other than HCC may be found in the cirrhotic liver, but they have different behavior on T2FS, DWI, transitional and late MR aquisitions, so the MRI should be preferred over CT as thereferenceimaging modality for the evaluation of cirrhotic patients due to its greater ability to detect and characterize focal liver lesions.
Although hepatocellular carcinoma is the most common tumoral lesion in a cirrhotic liver, there is a minor procent of 6-8% representing other substrat of hypervascular...
Personal information and conflict of interest
Dr. Carmen-Vasilica Iosub-resident doctor
Prof. Dr. Ioana.G. Lupescu
nothing to declare
UMPh"Carol Davila", Bucharest, Romania
Radiology, Medical Imaging and interventional Radiology Departament
Fundeni Clinical Institute
[email protected]
[email protected]
References
1.American College of Radiollogy: The LI-RADS v2018 Manual
2.Alvin C.Silva, Evans JM, McCulloughAE, Jatoi MA, Vargas HE, Hara AK: MR Imaging of hypervascular liver masses: a review of current techniques.2009; 29(2):385-402
3.Massimo Galia, Adele Taibbi, [...], and Giuseppe Brancatelli: Focal lesions in cirrhotic liver: what else beyond hepatocellular hepatocarcinoma. 2014; 20(3): 222–228
4.Roberto Cannella, Kathryn J. Fowler, Amir A. Borhani, Marta I. Minervini, Matthew Heller,1 and Alessandro Furlan: Common pitfalls when using the Liver Imaging Reporting and Data System (LI-RADS): lessons learned from a muli-year...