Differentiation of Hepatocellular Carcinoma from Hepatic Hemangioma and Focal Nodular Hyperplasia using Computed Tomographic Spectral Imaging

Abstract

Background and Aims: Hepatocellular carcinoma (HCC) is the most common primary hepatic malignancy. This study was designed to investigate the value of computed tomography (CT) spectral imaging in differentiating HCC from hepatic hemangioma (HH) and focal nodular hyperplasia (FNH). Methods: This was a retrospective study of 51 patients who underwent spectral multiple-phase CT at 40-140 keV during the arterial phase (AP) and portal venous phase (PP). Slopes of the spectral curves, iodine density, water density derived from iodine-and water-based material decomposition images, iodine uptake ratio (IUR), normalized iodine concentration, and the ratio of iodine concentration in liver lesions between AP and PP were measured or calculated. Results: As energy level decreased, the CT values of HCC (n=31), HH (n=17), and FNH (n=7) increased in both AP and PP. There were significant differences in IUR in the AP, IUR in the PP, normalized iodine concentration in the AP, slope in the AP, and slope in the PP among HCC, HH, and FNH. The CT values in AP, IUR in the AP and PP, normalized iodine concentration in the AP, slope in the AP and PP had high sensitivity and specificity in differentiating HH and HCC from FNH. Quantitative CT spectral data had higher sensitivity and specificity than conventional qualitative CT image analysis during the combined phases. Conclusions: Mean CT values at low energy (40-90 keV) and quantitative analysis of CT spectral data (IUR in the AP) could be helpful in the differentiation of HCC, HH, and FNH.

Focal Nodular Hyperplasia: A Comprehensive Review with a Particular Focus on Pathogenesis and Complications

“… 39 Indeed, one study compared morphologic and enhancement patterns using spectral CT to differentiate HCC from hemangiomas and FNHs. 40 The enhancement patterns were as described earlier for FNH while HCC showed rapid enhancement in the arterial phase and quick washout in the portal phase. However, the authors also described use of CT attenuation values and other quantifiable measurements (i.e.…”

Evaluation of qualitative and quantitative imaging features of hepatic hemangiomas with and without pseudo-washout sign on gadoxetic acid-enhanced MRI: a descriptive and comparative study

“…On US, homogeneous, hyperechoic, and well-defined nodules that could give posterior acoustic enhancement were defined as hemangioma (16). The following were regarded as hemangiomas: on triphasic CT, the classical contrast enhancement pattern (peripheral nodular enhancement in the AP, centripedal fill-in enhancement in the PVP, and prolonged enhancement in the TP) or early homogeneous enhancement during AP, persistent enhancement to TP, and isoattenuation relative to enhancing intrahepatic vessels; and on MRI, lesions with a high SI similar to that of cerebrospinal fluid on T2-weighted (T2W) images with typical enhancement patterns similar to those described on triphasic CT (2,3,5,6,17,18). The exclusion criteria were as follows: (i) lack of follow-up imaging examinations; (ii) assessment using only one imaging modality; (iii) poor image quality on dynamic MRI images; and (iv) had histologic or clinical evidence of chronic liver disease or liver cirrhosis.…”

“…Hemangiomas are asymptomatic and often do not require treatment, so it is important to make the correct diagnosis using non-invasive methods. Typical imaging features with a high specificity and sensitivity of hemangiomas in different imaging modalities have been described previously (2,3). Specifically, on triphasic computed tomography (CT) and Gd-DTPA-enhanced magnetic resonance imaging (MRI), typical hemangiomas are characterized by peripheral nodular enhancement in the arterial phase (AP), centripedal fill-in enhancement in the portal venous phase (PVP), and prolonged enhancement in the transitional phase (TP) (3)(4)(5)(6).…”

Radiomics Analysis on Noncontrast CT for Distinguishing Hepatic Hemangioma (HH) and Hepatocellular Carcinoma (HCC)

“…In noncontrast CT images, both the HCC and HH show similar low-density mass. The use of spectral CT can increase the sensitivity for differentiating small HHs from HCCs in the late arterial phase and portal venous phase [ 19 , 20 ]. The status of clear boundaries distinguished HH from HCC.…”