Metastatic nodules of hepatocellular carcinoma: detection with angiography, CT, and US.

Abstract

Accurate detection of intrahepatic metastases, or daughter nodules, of primary hepatocellular carcinoma is of crucial importance. Due to the introduction of infusion hepatic angiography, computed tomography (CT) after Lipiodol (iodized oil) infusion, and intraoperative ultrasound (US), tumors less than 10 mm in diameter are now frequently found. We compared the diagnostic accuracy of these three modalities in the detection of nodules in 45 patients who had hepatocellular carcinoma (confirmed by biopsy). CT with Lipiodol was superior to hepatic angiography in demonstrating nodules when they were overlapped by the primary tumor or very small in size. Intraoperative US demonstrated nodules in four avascular or hypovascular hepatocellular carcinomas, which both hepatic angiography and CT failed to demonstrate. In cases associated with severe liver cirrhosis, differentiation of small nodules from regenerating cirrhotic nodules was sometimes difficult with intraoperative US. The combined use of these three modalities is indispensable for the accurate detection of small nodules of metastatic hepatocellular carcinoma.

Intraoperative sonography of hepatocellular carcinoma: Detection of lesions and validity in surgical resection

“…This finding is comparable with those of others [8][9][10]. Intraoperative sonography had the best accuracy of the various imaging procedures.…”

“…Therefore, additional diagnostic procedures are necessary to determine operability and the best operative method. Intraoperative sonography is useful in this setting and has been used by Japanese physicians [8][9][10]. However, to our knowledge, the validity of intraoperative sonography in the surgical resection of HCCs has not yet been reported in the English literature.…”

Hepatocellular carcinoma: Prospective assessments of the T-factor with CT, US, and MR imaging

“…US tended to overestimate regenerating nodules as being IMs. When associated liver cirrhosis was severe, differentiating small HCCs from regenerating cirrhotic nodules is extremely difficult [19]. In liver cirrhosis, the liver parenchyma is reconstructed of various sizes of regenerating nodules; this renders the parenchymal echo pattern in the cirrhotic liver very irregular.…”

Intrahepatic metastatic nodules of hepatocellular carcinoma detected at Lipiodol-CT: imaging-pathologic correlation

“…HCC tumors, however, may be frequently accompanied by small intrahepatic metastastic nodules [6,7]. Underestimation of these satellite lesions may lead to unappropriate surgical resections, followed by early postoperative recurrence [8].…”