Depiction of Viable Tumor in Hepatocellular Carcinoma Treated with Transarterial Chemoembolization: Multiphasic Helical CT with Review of the Previous Serial CT Images

OBJECTIVE: The purpose of our study was to assess whether a review of multiphasic helical CT combined with the previous serial CT images could be helpful to depict a viable tumor in hepatocellular carcinoma treated with transarterial chemoembolization. MATERIALS AND METHODS: Twenty-four consecutive patients with 35 hepatocellular carcinomas underwent transarterial chemoembolization followed by hepatic resection. First, three radiologists independently analyzed the last CT images taken before resection for the presence of viable tumor. A second analysis was then performed using the last CT combined with the previous serial CT images. The CT analyses were then compared with the pathologic results. The added value of the review of the previous serial CT images was evaluated by performing a receiver operating characteristic analysis. The sensitivity, specificity and diagnostic accuracy for the depiction of viable tumor were also assessed, and the characteristics of the false-negative lesions were pathologically evaluated. RESULTS: The mean diagnostic accuracies (Az values) for the depiction of viable tumor with using the last CT alone and with the review of the previous serial CT images for all observers were 0.885 and 0.901, respectively, which were not significantly difference (p> 0.05). However, the additional review of the previous serial CT images allowed the observers to render a correct diagnosis for three lesions that had been incorrectly diagnosed with the review of last CT alone. The sensitivity, specificity and diagnostic accuracy of the last CT along with the review of the previous serial CT images were 78%, 97% and 84%, respectively. All of the 16 false-negative lesions diagnosed by each observer showed 90% or greater necrosis on the pathologic examination. CONCLUSION: For the depiction of viable tumor in hepatocellular carcinoma treated with transarterial chemoembolization, although the difference in the diagnostic accuracies was not statistically significant, a review of the multiphasic helical CT combined with the previous serial CT images could help reach a correct diagnosis for those lesions incorrectly diagnosed with the review of the last CT alone.

Primary Hepatic leiomyosarcoma: A case Report

Primary hepatic leiomyosarcoma is a rare tumor, most frequently occurring in liver parenchyma. We recentlyencountered an exophytic hepatic leiomyosarcoma ; CT scans indicated an indistinct border, with the parenchyme ofthe liver and parenchymal beaking suggesting a primary hepatic mass. We present an unusual case of primaryleiomyosarcoma which showed exophytic growth.

The Imaging Findings of Small(< or =15mm) Portal Defects in the Liver on CT Arterial Portography: Evaluationwith CT Hepatic Arteriography and Lipiodol CT

PURPOSE: To assess the malignant potential of small(< or =15mm) portal defects seen on CT arterial portography,the findings of CT hepatic arteriography and lipiodol CT CT were reviewed. MATERIALS AND METHODS: In 91 patientswho underwent both CTAP and CTHA, small portal defects were re-viewed for frequency, multiplicity and location. Weprospectively evauluated changes in the size and enhance-ment pattern of malignant lesions on follow up CTaccording to density on CTHA, location, lipiodol deposits on lipiodol CT, and multiplicity. RESULTS: Among the 91patients, 102 small defects were defected in 42 patients(46%). Small portal defects were benign, malignant, and ofundetermined malignant potential in 77%, 20% and 3% of cases, respectively. Small portal defects that werehyperattenuated on CTHA, and lipiodol deposits on lipiodol CT, were malignant in 42% and 70% of cases,respectively. Location and multiplicity did not show statistically significant variation between benign andmalignant defects. CONCLUSION: Small portal defects are common and there is a high probability that portaldefects smaller than 15mm are benign, even in patients with a known hepatic mass and defect that washyperattenuated on CTHA. If a small defect showed lipiodol deposit on lipiodol CT, malignancy must be suspected.

CT and MR Findings of Primary Hepatic Leiomyosarcoma: A Case Report

We describe the CT and MR findings of primary leiomyosarcoma of the liver and review the radiological findings of the previous reports of this disease. A 35-year-old woman presented with discomfort in the right upper quadrant of the abdomen. On contrast-enhanced CT, a well circumscribed and lobulated, homogeneously hypoattenuating solid mass with slight peripheral enhancement was identified in the caudate lobe of the liver. On spin-echo MR imaging, the tumor showed homogeneous hypointensity on T1-weighted images and hyperintensity on T2-weighted images. Contrast-enhanced T1-weighted imaging showed markedly heterogeneous enhancement throughout the mass.

Pattern analysis of Hemodynamic Changes of the Liver on Combined CT Hepatic Arteriography and CT Arterial Portography

PURPOSE: To evaluate the patterns of hemodynamic changes caused by various pathologic liver conditions. MATERIALS & METHODS: Combined CT hepatic arteriography(CTHA) and CT arterial portography(CTAP), performed in 185 consecutive patients, including 150 with hepatocellular carcinoma, were retrospectively analysed. Of these patients, 48 showed various patterns of hemodynamic change. such change caused by occlusion, stenosis and/or cavernous transformation of the portal vein, by occlusion or stenosis of the hepatic artery, or by the presence of arterioportal(AP) shunt could be classified as follows : type 1, decreased or absent portal flow ; type 2,decreased or absent hepatic arterial flow ; type 3, AP shunt without portal tumor thrombus(PTT) ; and type 4, PTT with transvasal AP shunt, including the presence of cavernous transformation of the portal vein. RESULTS: Type I (n=20) showed hyperattenuation of both PTT and absent portal flow area on CTHA, and reciprocally consistent hypoattenuation on CTAP. Type II (n=6) showed a hypoattenuating area on CTHA, and isoattenuation or slightly hyperattenuation on CTAP. Type III (n=9) showed an oval or wedge-shaped hyperattenuating area on CTHA, anddefective perfusion at the same area on CTAP. In Type IV (n=13), both CTHA and CTAP showed variable findings, according to the amount of transvasal AP shunt, the location and extent of PTT, and/or cavernous transformation ofthe portal vein. CONCLUSION: Pattern analyses of hemodynamic changes on both CTHA and CTAP are helpful inclarifying the primary causes of hemodynamic changes in the liver.