Enhancement patterns of hepatocellular carcinomas on multiphasic multidetector row CT: comparison with pathological differentiation

Abstract

Objective: The objective of this study was to determine the incidence of typical and atypical enhancement patterns of hepatocellular carcinomas (HCCs) on multiphasic multidetector row CT (MDCT) and to correlate the enhancement patterns and morphological image findings of HCC with the degree of tumour differentiation. Methods: MDCT images of 217 patients with 243 surgically proven HCCs were evaluated through consensus reading by two radiologists. Our MDCT protocol was composed of precontrast, arterial, portal and delayed phases. The reviewers analysed the CT images for degree of attenuation; relative timing of washout; presence of dysmorphic intratumoral vessels, aneurysms and necrosis; tumour size; tumour margin; presence of pseudocapsule; intratumoral heterogeneity; and determined enhancement pattern. The imaging features were correlated with tumour differentiation using Fisher's exact test or the x 2 test. Results: Among 243 HCCs, 137 (56.4%) showed the typical enhancement pattern of HCC, which is arterial enhancement and washout on portal or equilibrium phase images. In the arterial phase, 190 of 243 (78.2%) HCCs showed hypervascularity, with approximately three quarters of poorly differentiated (PD) (34 of 45, 75.6%) and moderately differentiated (MD) HCCs (92 of 123, 74.8%) showing washout during the portal or delayed phases, vs only 50% of well-differentiated (WD) HCCs (11 of 22; p,0.048). The presence of intratumoral vessels and aneurysms, tumour necrosis, attenuation of precontrast, the relative timing of washout, intratumoral attenuation heterogeneity, tumour margin and tumour size were correlated with the pathological differentiation of HCCs (p,0.05). Conclusion: A typical enhancement of HCCs on MDCT was not unusual (43.6%) and WD and PD HCCs account for most of the atypical enhancement patterns. Early washout favoured MD and PD HCCs rather than WD HCCs, whereas in our study the presence of intratumoral aneurysm was a highly specific finding for PD HCC.

Transarterial Chemoembolization with and without Microballoon Occlusion for Hypovascular Hepatocellular Carcinoma

“…In the present case, recurrent tumor after first combined C-TACE and B-TACE with RFA had a rich hypovascular component, and it showed a high ADC value with a high AFP level. Some studies reported that the proportion of hypovascular tumors on CT was higher in well-differentiated HCC (wHCC) and pHCC than in mHCC [3], and Oishi et al reported that a serum AFP level more than 400 ng/mL might be a useful criterion for predicting pHCC [9]. Additionally, Guo et al reported that the ADC value for pHCC was (1.16 0.16) 10 -3 mm 2 /s, and that it was significantly lower than that for wHCC and mHCC [10].…”

“…It is known that the vascular system of HCC changes with the degree of tumor differentiation [3,4], and that the therapeutic effects of TACE may depend on tumor vascularity [5]. Hypovascular HCC has a poor arterial blood supply, so it is difficult to control with conventional TACE (C-TACE) [4,6].…”

Radiological diagnosis of hepatocellular carcinoma in non-cirrhotic patients

“…Thus, in a retrospective study of 243 patients conducted by Lee et al, [5] the most typical behavior of tumors corresponded to moderately differentiated HCC. A high percentage of cases showed atypical behavior (43.6%).…”

Model Matters: Differences in Orthotopic Rat Hepatocellular Carcinoma Physiology Determine Therapy Response to Sorafenib

“…A high level of tumor perfusion provides the rationale for antiangiogenic and TACE treatment in human HCC, and thus should be reflected in a preclinical model system. Furthermore, variability in tumor perfusion has also been described for human HCC, where it correlates with tumor grading, thus presenting a potential biomarker of histopathologic grading (35). Considering the potential of metabolic imaging in tumor characterization and response monitoring, for example, by FDG-PET or hyperpolarized 13C metabolite magnetic resonance spectroscopy imaging, quantitative assessment of tumor perfusion may aid in the validation of such imaging markers.…”