Early hepatocellular carcinoma: appearance at CT during arterial portography and CT arteriography with pathologic correlation.

Takayasu, Kenichi; Muramatsu, Yukio; Furukawa, Hiroyoshi; Wakao, Fumihiko; Moriyama, Noriyuki; Takayama, Tadatoshi; Yamasaki, Susumu; Sakamoto, Michiie; Hirohashi, Setsuo

doi:10.1148/radiology.194.1.7997534

Cited by 127 publications

(102 citation statements)

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“…1,4 What is the diagnostic approach to early HCC? To maximize chances for identification, we used up to six imaging methods, including angiographic CT and Lipiodol-CT. 10 These additional methods resulted in fulfillment of the diagnostic criteria in 25 patients (of whom 10 had early HCC). The risk of overdiagnosis (3 of 70 cases [4.3%]), however, was almost similar to that (21 of 590 cases [3.6%]) 23 reported in a study of patients in whom HCC was diagnosed on the basis of currently accepted standards.…”

Section: Discussionmentioning

confidence: 99%

Early Hepatocellular Carcinoma As An Entity With A High Rate of Surgical Cure

Takayama

Makuuchi

Hirohashi³

et al. 1998

Hepatology

373

273

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Early hepatocellular carcinoma (HCC) has been defined as a well-differentiated cancer containing Glisson's triad, but it remains unknown whether this lesion is curable. We prospectively studied 70 patients (enrolled from 1,172 referrals between 1982 and 1991) who had a diagnosis of a single HCC 2 cm or less in diameter (Stage T1) and who underwent curative hepatectomy and long-term follow-up (range, 0.2 to 14.3 years). Patients were eligible for surgery if they had a tumor that met the diagnostic criteria for HCC and were in Child-Pugh class A (n ‫؍‬ 59) or B (n ‫؍‬ 11) status. Among the 70 patients, there was 1 operative death. Based on our typing system, the tumors were assigned as early HCC (n ‫؍‬ 15), overt HCC (n ‫؍‬ 52), and non-HCC tumor (n ‫؍‬ 3). The rate of microscopic regional spread was lower in early HCCs than in overt HCCs (7% vs. 42%; P ‫؍‬ .01). The early HCC group had a longer time to recurrence than did the overt HCC group (3.9 vs. 1.7 years; P F .001) and had no local recurrence. After a median follow-up of 6.3 years, both overall survival and recurrence-free survival in the early HCC group were significantly better than those in the overt HCC group (P ‫؍‬ .01; P ‫؍‬ .001). In these two groups, the 5-year rates of overall survival were 93% and 54% (P ‫؍‬ .01), and those of recurrence-free survival were 47% and 16% (P ‫؍‬ .05), respectively; a significant survival benefit persisted over a decade (57% vs. 21%; P ‫؍‬ .05). The early HCC group was at a lower risk of recurrence (relative risk, 0.31; 95% CI, 0.15 to 0.65; P ‫؍‬ .002) and death (relative risk, 0.26; 95% CI, 0.09 to 0.73; P ‫؍‬ .01) than was the overt HCC group. Early HCC is a distinct clinical entity with a high rate of surgical cure, thereby justifying its definition. It can be a lesion that corresponds to ''Stage 0'' cancer in other organs. (HEPATOLOGY 1998;28:1241-1246

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Section: Discussionmentioning

confidence: 99%

Early Hepatocellular Carcinoma As An Entity With A High Rate of Surgical Cure

Takayama

Makuuchi

Hirohashi³

et al. 1998

Hepatology

373

273

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“…77 Finally, early HCCs can show washout on delayed-phase dynamic CT or decreased portal perfusion on CT during arterial portography. 79 Though the use of conventional imaging modalities to diagnose early HCC has been challenging, the use of gadoxetic acid-enhanced MR imaging may at least partly alleviate this problem. Speciˆ-cally, early HCCs may appear on hepatocyte phase images as clearly hypointense, hypovascular lesions in cirrhotic livers.…”

Section: Advantage Of Assessing Multi-step Hepatocarcinogenesis: Assementioning

confidence: 99%

Rules, Roles, and Room for Discussion in Gadoxetic Acid-enhanced Magnetic Resonance Liver Imaging: Current Knowledge and Future Challenges

Ichikawa

Araki

2013

magn reson med sci

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Since its launch onto the world medical market, gadoxetic acid has received a great deal of attention from a diverse group of researchers, including gastroenterologists, hepatologists, and abdominal radiologists. Gadoxetic acid in liver magnetic resonance (MR) imaging might be considered to have excellent utility. However, several issues remain that radiologists should keep in mind when utilizing this product. We compiled this review to introduce gadoxetic acid, describe how it should be used, highlight the situations in which it is most and least reliable, and suggest potential avenues for future research.

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“…Assessment of tumour vascularity and for the presence of Kupffer cells are important in differential diagnosis, the choice of treatment and for assessment of the therapeutic response. HCC tumour vascularity has been evaluated extensively using various imaging modalities, including colour or power Doppler ultrasonography [1,2], angiography, dynamic CT [3], CT during angiography [4,5] and MRI [3]. Dynamic helical CT is minimally invasive and provides information regarding arterial or portal supplies by scanning at different time intervals following an injection of contrast agent.…”

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confidence: 99%

Assessment of hepatocellular carcinoma by contrast-enhanced ultrasound with perfluorobutane microbubbles: comparison with dynamic CT

Mandai¹,

Koda²,

Matono³

et al. 2011

BJR

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Objective: The aim of this study was to evaluate tumour vascularity and Kupffer cell imaging in hepatocellular carcinoma (HCC) using contrast-enhanced ultrasonography (CEUS) with Sonazoid (perfluorobutane) and to compare performance with dynamic CT. Methods: We studied 118 nodules in 88 patients with HCC. HCC was diagnosed as a hyperenhancement lesion in the arterial phase with washout in the portal phase on dynamic CT or by percutaneous biopsy. We observed tumour vascularity at the early vascular phase (10-30 s after contrast injection) and Kupffer imaging at the postvascular phase (after 10 min). Results: Detection of vascularity at the early vascular phase was 88% in nodules that were found to be hypervascular on dynamic CT and 28% in hypo-/isovascular nodules; the detection of local recurrence nodules was 92%. The detection of vascularity was significantly lower in nodules .9 cm deep than in those #9 cm deep, but was not affected by tumour size. The detection of tumours at the post-vascular phase on CEUS was 83% in nodules with low density in the portal phase on dynamic CT and 82% in nodules with isodensity. The rate did not depend on the severity of underlying liver disease; rates decreased in nodules deeper than 9 cm, those smaller than 2 cm in diameter and in iso-enhancing nodules at the early vascular phase of CEUS. Conclusion: CEUS with Sonazoid is a useful tool for assessing the vascularity of HCC and is equal to that of dynamic CT; however, the detectability of HCC vascularity is affected by location.

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Early hepatocellular carcinoma: appearance at CT during arterial portography and CT arteriography with pathologic correlation.

Abstract: CTAP, the standard of reference for the detection of small HCC, is not sensitive enough for the detection of early HCC.

Cited by 127 publications

References 0 publications

Early Hepatocellular Carcinoma As An Entity With A High Rate of Surgical Cure

Early Hepatocellular Carcinoma As An Entity With A High Rate of Surgical Cure

Rules, Roles, and Room for Discussion in Gadoxetic Acid-enhanced Magnetic Resonance Liver Imaging: Current Knowledge and Future Challenges

Assessment of hepatocellular carcinoma by contrast-enhanced ultrasound with perfluorobutane microbubbles: comparison with dynamic CT

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