The pseudocapsule in hepatocellular carcinoma: correlation between dynamic MR imaging and pathology

Grazioli, Luigi; Olivetti, Lucio; Fugazzola, Carlo; Benetti, Anna; Stanga, Chiara; Dettori, Ernesto; Gallo, Cristina; Matricardi, L; Giacobbe, Antonio; Chiesa, A.

doi:10.1007/s003300050629

Cited by 92 publications

(71 citation statements)

References 13 publications

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“…On imaging, the capsule is seen as a low-attenuating/hypointense ring on arterial phase and high-attenuating/hyperintense ring on delayed phase images (13,15) (Fig. 1).…”

Section: Capsulementioning

confidence: 99%

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Microvascular invasion in hepatocellular carcinoma

Ünal

İdilman

Akata³

et al. 2016

Diagn Interv Radiol

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H epatocellular carcinoma (HCC) is responsible for high incidence of cancer-related mortality worldwide (1, 2). Diagnosis of HCC is a well-known topic, and now it can be made solely by imaging findings in cirrhosis (3,4). Advances in imaging procedures and intense follow-up of high-risk patients led to increased early detection of HCC and better treatment options (5, 6). However, even in good surgical candidates, long-term survival rates remain unsatisfactory because of high recurrence (7,8). Presence of microvascular invasion (MVI) has been reported to be one of the most important risk factors related to postsurgery tumor recurrence (9-11). Presence of MVI alters the surgical procedure. MVI is a prognostic factor associated with lower survival and higher recurrence rates. Prediction of MVI may also affect locoregional treatments along with chemotherapy protocols. This review will focus on all aspects of MVI. The effect of microvascular invasion on survivalEarly tumor recurrence is linked to increased mortality rate. Lim et al. (9) reported that MVI is a more prominent tumor recurrence predictor than the Milan criteria for HCC after surgical resection. The patients who fulfill the Milan criteria should have a solitary tumor not exceeding 5 cm or three or fewer tumors with the largest not exceeding 3 cm, and no evidence of macrovascular invasion or extrahepatic metastasis (5, 9). Lim et al. (9) concluded that patients (without MVI) exceeding the Milan criteria could achieve comparable overall survival rates after surgical resection, relative to patients within the Milan criteria. However, overall survival decreased significantly with MVI, independently of the Milan criteria.In a different study, authors grouped the patients into mild (one to five invaded vessels) and severe (more than five invaded vessels) MVI groups (5). They found that the three-year recurrence-free survival rates for patients with and without MVI were 27.7% and 62.5%, respectively. They also reported that recurrence-free survival rates at two years for patients without MVI, with mild MVI, and severe MVI were 75.9%, 47.2%, and 32.7%, respectively (5). Goh et al. (12) studied patients who had surgical resection of multifocal HCC and revealed that the presence of MVI and the number of nodules (which is also a result of MVI) were more important prognostic factors than tumor size (12). They also suggested that the current American Joint Committee for Cancer TNM staging system, which uses tumor size, but not MVI, as prognostic criteria for multifocal HCC, needs to be revised (12). The indicators of microvascular invasionDespite its significance in HCC assessment, MVI can rarely be diagnosed preoperatively. However, the presence of MVI may be predicted by key radiologic findings and specific lab- We reviewed the literature and aimed to draw attention to clinicopathologic and imaging findings that may predict the presence of microvascular invasion in hepatocellular carcinoma. Imaging findings suggesting microvascular invasion are disruption of capsule...

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“…On imaging, the capsule is seen as a low-attenuating/hypointense ring on arterial phase and high-attenuating/hyperintense ring on delayed phase images (13,15) (Fig. 1).…”

Section: Capsulementioning

confidence: 99%

“…1). The microvessels in the capsule are thought to be responsible for the late enhancement because of slow flow (13,15).…”

Section: Capsulementioning

confidence: 99%

Microvascular invasion in hepatocellular carcinoma

Ünal

İdilman

Akata³

et al. 2016

Diagn Interv Radiol

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“…Secondly, the tumor grew invasively, so that the normal hepatic cell and the tumor cell interlaced with each other at the borderline. Grazioli et al [6] reported that the tumor without fibrous pseudo-capsule lacked fibrous connective septum between carcinomatous tissue and normal hepatic parenchyma histologically, carcinomatous tissue and normal hepatic parenchyma interlaced each other without obvious borderline. After enhancement, especially in the portal venous phase, the adjacent hepatic parenchyma was enhanced obviously, in contrast, the lesion were enhanced slightly.…”

Section: The Ct Appearance Of the Border Of Lesionsmentioning

confidence: 99%

Small hepatocellular carcinoma keeping hypodense during dual phase helical CT scan and correlative pathology

Shen¹,

Gao²,

Zhao³

et al. 2013

JBGC

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Rationale and Objectives: To evaluate the dual-phase helical computed tomography (CT) appearance of small hepatocellular carcinoma (SHCC) with hypodense and to evaluate its correlation with pathology. Materials and Methods:The helical CT dual-phase appearance of 33 lesions with keeping hypodense was retrospectively analyzed, all lesions were confirmed as SHCC by histopathology. CT appearance included border, inner density. Results:In 33 lesions, which were confirmed as SHCC by pathology, keeping hypodense during hepatic arterial phase and portal venous phase, 19 lesions are ill-defined borders and 14 lesions are well-defined borders, 22 lesions show homogenous hypodense and 11 lesions show heterogeneous hypodense in non-enhancing CT scan; however, only 9 lesions are ill-defined borders and the other 24 lesions are well-defined borders with slightly irregular contours, only 9 lesions show homogenous hypodense and the other 24 lesions show heterogenous hypodense with flecks of more hypodense in enhancing CT scan.Conclusion: SHCC with hypodense prefers to have a well-defined border with slightly irregular contour, and flecks of more hypodense in the lesion in dual-phase enhancing helical CT scan.

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“…This classification was made on the basis of accepted findings and experience with the use of MRI in human patients. 23,[41][42][43][44][45][46][47][48][49][50][51][52][53][54][55][56][57][58][59][60] For each patient, the characterization of the lesion by MRI was correlated with the histopathology or cytology results. For animals in which a biopsy or an aspiration of a lesion was performed before MRI (n ϭ 26), the location of the specific lesion was recorded for comparison with the location of the lesion on MRI.…”

Section: Mri Analysismentioning

confidence: 99%

“…Additionally, in one animal, a thin hypointense rim was noted around the tumor, which is characteristic of a capsule or pseudocapsule that, in humans, has been confirmed on histopathology. 22,52,65 The ability to estimate tumor grade on the basis of contrast enhancement is commonly reported in human medicine but has not been described previously in veterinary medicine. 22,65 Dynamic contrast administration provides clinicians with additional useful information about specific lesions and enables lesion examination during 3 phases: arterial (20-30 seconds postinjection), portal (1 minute postinjection), and delayed or equilibrium (3-5 minutes postinjection).…”

Section: Fig 2 (A)mentioning

confidence: 99%

Magnetic Resonance Imaging of Focal Splenic and Hepatic Lesions in the Dog

Clifford

Pretorius

Weisse

et al. 2004

Veterinary Internal Medicne

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Focal hepatic and splenic lesions in the dog are common, and approximately half of such lesions are malignant. Both incidentally discovered lesions and lesions in patients with known malignancies represent diagnostic dilemmas. Ultrasound often fails to characterize such lesions adequately. This uncertainty may result in unnecessary splenectomies and liver biopsies for benign lesions or noncurative surgery for advanced-stage malignancies. In humans, ultrasound largely has been supplanted by computed tomography and magnetic resonance imaging (MRI) for the characterization of focal hepatic and splenic lesions. The inherently high soft tissue contrast of MRI allows the differentiation of benign from malignant hepatic and splenic lesions in the human patients. In this prospective study, 35 focal lesions of either the spleen (n ϭ 8) or the liver (n ϭ 27) were characterized by MRI in 23 dogs. Lesions were presumptively classified as malignant or benign on the basis of MRI findings. Imaging results then were correlated with histopathologic (29) or cytologic (6) evaluation of the lesions. The overall accuracy in differentiating malignant from benign lesions was 94% (33 of 35 lesions). The overall sensitivity and specificity were 100% (95% CI, 78-100%) and 90% (95% CI, 68-99%), respectively. MRI classified malignant hepatic lesions as hepatocellular carcinoma (HCC) in all confirmed cases and correctly predicted the histologic grade of 5 HCC lesions. These results suggest that MRI is a useful modality for abdominal imaging in veterinary patients, and MRI accurately differentiated benign from malignant focal hepatic and splenic lesions in this sample of patients.Key words: Abdominal imaging; Hemangiosarcoma; Hepatocellular carcinoma; Nodular hyperplasia.I n the canine liver, focal lesions may represent benign (eg, focal nodular hyperplasia [FNH] or regeneration, extramedullary hematopoiesis, cyst, abscess, hematoma) or malignant (eg, hepatocellular carcinoma [HCC], lymphosarcoma, malignant histiocytosis, hemangiosarcoma, metastatic carcinoma, metastatic sarcoma) processes. [1][2][3][4] Similarly, focal lesions in the spleen may be the result of benign (eg, lymphoid hyperplasia, cyst, abscess) or malignant (eg, hemangiosarcoma, metastatic sarcoma/carcinoma, malignant histiocytosis, lymphosarcoma) conditions. 5-8 These lesions traditionally have been identified by radiography or ultrasonography and commonly represent a diagnostic dilemma for the clinician, because each may require substantially different management. 1,2 Ultrasound is commonly used for abdominal imaging in veterinary medicine, but its ability to distinguish benign from malignant lesions in the liver and spleen is poor. 9-12 Consequently, unnecessary surgeries or biopsies may be performed on patients with benign lesions.In humans, the limitations of ultrasound are well recognized, and its role in specific patients is limited. Magnetic resonance imaging (MRI) provides soft tissue contrast that is far superior to that provided by either ultrasound or computed to...

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The pseudocapsule in hepatocellular carcinoma: correlation between dynamic MR imaging and pathology

Cited by 92 publications

References 13 publications

Microvascular invasion in hepatocellular carcinoma

Microvascular invasion in hepatocellular carcinoma

Small hepatocellular carcinoma keeping hypodense during dual phase helical CT scan and correlative pathology

Magnetic Resonance Imaging of Focal Splenic and Hepatic Lesions in the Dog

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