ABSTRACT
Background: A spontaneously ruptured hepatocellular carcinoma (HCC) carries an extremely poor prognosis and high mortality. In Thailand, the reported incidence of ruptured HCC was 12.4 % . Objective: To evaluate the computed tomography (CT) findings of ruptured HCC at King Chulalongkorn Memorial Hospital, Thailand. Methods: We reviewed the CT findings of 15 patients who were diagnosed as having a ruptured HCC and underwent CT scan of the upper abdomen. Two experienced radiologists analyzed the CT findings regarding the tumor’s size, tumor’s number, location, hepatic segment involvement, contour protrusion including appearance of the mass and ascites. Results: The study population consisted of 15 men with mean age of 57.4 years (27-78 years). All cases showed liver cirrhosis. All ruptured tumors were located at the periphery of the liver and had a protruding contour. The maximum diameter of the tumors ranged from 2.8-17.2 cm (mean 7.44 cm). Marginal disruption was seen in 9 cases (60 %). Five cases (33 %) presented with hematoma and high attenuation around the ruptured mass. All cases of ruptured HCC had ascites. Conclusion: The peripheral location, protruding contour, marginal disruption of the tumor with the background of a cirrhotic liver are highly suggestive of ruptured HCC.
ABSTRACT
Background: Superparamagnetic iron oxide (SPIO) is a new paramagnetic contrast agent used to distinguish benign and malignant hepatic tumors on magnetic resonance imaging (MRI). Objective: This prospective study was designed to compare detectability of malignant hepatic tumors using gadolinium (Gd) versus SPIO-enhanced (MRI). Methods: We selected fifteen patients suspected of malignant hepatic tumors of less than 5 cm in size. They included hepatocellular carcinoma (HCC) and hepatic metastasis. A dynamic Gd-enhanced study was performed first and followed by SPIO-enhanced study with time interval of 4 hours to one week. We performed fast spin echo T2 weighted image (FSE T2WI) with fat suppression, fast multiplana gradient echo T2* weighted image (FMPGR T2*WI), and single-shot FSE T2WI with fat suppression on SPIO study. All lesions were confirmed by histopathology, high Alpha fetoprotein level or follow up imaging. Both studies were analyzed by two independent radiologists. Results: The study included 11 cases (6 HCCs and 5 metastases). Four cases of benign lesions and unconfirmed diagnosis were excluded (2 cases of regenerating nodules and 2 cases of unconfirmed diagnosis). Range of sizes was 0.5-7.5 cm (mean = 2.0 cm). In quantitative analysis, SPIO could detect higher numbers of lesions compared with Gd, especially for small lesions (≤ 2 cm) and for HCCs. There was no difference between SPIO and Gd for detection of large malignant lesions (\>2 cm). Gd-enhanced MRI was better than SPIO for detection of the numbers of hepatic metastases. SPIO showed better imaging quality compared to Gd and the best MR sequence was FMPGR T2*WI. Conclusion: SPIO-enhanced MRI was superior to Gd-enhanced MRI for detection of small HCC, whereas Gd-enhanced MRI was better for detection of small hepatic metastases.
ABSTRACT
Background: Measurement of liver volume has been used in planning radiotherapy dosimetry, assessing the progressiveness of various diseases and measuring the response to treatment. Objective: To measure liver volume using multidetector computed tomography (MDCT), and to evaluate the accuracy and inter-observer reliability of liver volume measurement using MDCT. Methods: Measurements were done using a track-ball to draw its outline manually, and calculate by summation of each slice volume which was measured in 8 mm thickness. The calculated liver volume was compared to the actual liver volume which was measured by water replacement. Results and conclusion: There was a strong correlation between the calculated and actual liver volumes performed by a radiologist and a technician (98.0% and 97.1% agreement, respectively). High observer reliability was identified (99.2% agreement). This technique can be easily used by well-trained personnel such as radiologists or technicians.