Hypervascular Hyperplastic Nodules Appearing in Chronic Alcoholic Liver Disease: Benign Intrahepatic Nodules Mimicking Hepatocellular Carcinoma

PURPOSE: Hypervascular hyperplastic nodules in those patients with chronic alcoholic liver disease and who are hepatitis B and C negative have recently been reported on. The purpose of this study was to correlate the radiologic and pathologic findings with the clinical significance of these hypervascular hyperplastic nodules in chronic alcoholic liver disease. MATERIALS AND METHODS: The study included eight hypervascular nodules of seven patients with chronic alcoholic liver disease, and these patients had abused alcohol for more than 20 years. Eight hypervascular nodules were seen on the arterial phase of dynamic CT scans, but the possibility of HCC was excluded pathologically (n=4) or clinically. The radiologic and pathologic findings, and the changes of these nodules on follow up CT scans were retrospectively analyzed. RESULTS: All nodules showed good enhancement on the arterial phase. The tissue equilibrium phase of the dynamic CT scans showed isodensity in seven patients and low density in one patient. Ultrasound scans revealed hypoechoic findings for three nodules, isoechoic findings for two nodules, hyperechoic findings for one nodule, and two nodules were not detected. Angiograms (n=6) showed late incremental tumor staining, and all the nodules were well seen on the sinusoidal phase. CT during hepatic angiography (n=4) showed well stained tumor. CT during arterial portography (n=4) showed no defect in three nodules and nodular defect in one nodule. The MR images (n=3) showed low signal intensity in two nodules and iso-signal intensity in one nodule on T2WI. Five of six cases for which follow up CT scans were performed showed decrease in size and one was disappeared. CONCLUSION: Radiologically, it is often difficult to differentiate the hypervascular hyperplastic nodules seen in the chronic alcoholic liver disease from hepatocellular carcinoma, and histological confirmation is needed for excluded hepatocellular carcinoma. However, late tumor staining during the sinusoidal phase without any blood supply by feeding vessels or any arterioportal shunt on the angiogram, isodensity during the tissue equilibrium phase of dynamic CT and low signal intensity on T2WI may suggest the presence of hypervascular hyperplastic nodule.

Transcatheter Arterial Chemoembolization of Hepatocellular Carcinoma: Prevalence and Causative Factors of Extrahepatic Collateral Arteries in 479 Patients

OBJECTIVE: We wanted to investigate the prevalence and causative factors of extrahepatic arterial blood supply to hepatocellular carcinoma (HCC) at its initial presentation and during chemoembolization. MATERIALS AND METHODS: Between February 1998 and April 2000, consecutive 479 patients with newly diagnosed HCC were prospectively enrolled into this study. A total of 1629 sessions of transcatheter arterial chemoembolization (TACE) were performed in these patients (range: 1-15 sessions; mean: 3.4 sessions) until April 2004. For each TACE procedure, we determined the potential extrahepatic collateral arteries (ExCAs) depending on the location of the tumor, and we performed selective angiography of all suspected collaterals that could supply the tumor. The prevalence of ExCAs and the causative factors were analyzed. RESULTS: At initial presentation, 82 (17%) of these 479 patients showed 108 ExCAs supplying tumors. Univariate analysis showed that tumor size (p or = 5 cm) was significantly higher than that for those patients with a small tumor (< 5 cm) (p < 0.01). CONCLUSION: The presence of ExCAs supplying HCC is rather common, and the tumor size is a significant causative factor for the development of these collateral arteries.

Massive Tumor Pulmonary Embolism Following Transcatheter Arterial Chemoembolization of Hepatocellular Carcinoma

Pulmonary embolism complicated by transcatheter arterial chemoembolization (TACE) is known to be due to the use of large amount of lipiodol as an embolic agent. To our knowledge, massive tumoral pulmonary embolism following TACE and confirmed by surgery has not been described in the literature. In this report, we detail the case of a 49-year-old man in whom cyanosis and hypotension developed abruptly on the day of TACE. Chest CT revealed diffuse low-attenuated lesions in both pulmonary arteries. Histopathological specimens after emergent pulmonary arterial embolectomy confirmed the presence of massive tumor emboli of hepatocellular carcinoma.

Hepatocellular Carcinoma: Comparison Study on Detecting Tumor Vascularity among Various Imaging Techniques

PURPOSE: To compare the detectability of tumor vascularity using triphasic spiral CT, angiography, CT during hepatic arteriography(CTHA) and single-level dynamic CTHA(SLD-CTHA). MATERIALS AND METHODS: Seventy-nine pathologically confirmed nodular hepatocellular carcinomas(HCCs) in 77 patients were included in this study. Sixty patients were male and 17 were female, and their ages ranged from 31 to 77 (average, 57.4) years. HCCs were classified into three groups according to the size: less than 2 cm (n=20), 2 -4 cm (n=32), and more than 4 cm (n=27) in diameter. If a portion of tumor demonstrated greater enhancement than surrounding liver parenchyma, vascularity was deemed to be present. Detectability by each imaging technique was compared according to size and overall. RESULTS: Hypervascularity was frequently detected by SLD-CTHA [90.9%(40/44)], followed by CTHA[88.0%(66/75)], angiography [80.3%(61/76)], triphasic spiral CT [72.4%(42/58)]. In the less than 2 cm group, detectability rates for triphasic spiral CT, angiography, CTHA and SLD-CTHA were 53.3%(8/15), 55.6%(10/18), 76.5%(13/17) and 87.5%(6/7), respectively. while the 2 -4 cm group demonstrated corresponding figures of 71.4%(15/21), 78.1%(25/32), 84.4%(27/32) and 86.4%(19/22). In the more than 4 cm group, the rate for triphasic spiral CT was 86.4%(19/22), while for angiography, CTHA and dynamic CTHA, it was 100%. CONCLUSION: In the detection of hypervascularity of HCC, SLD-CTHA showed the highest rate, followed by CTHA, angiography, and triphasic spiral CT. In HCCs less than 4 cm in diameter, the corresponding ordering was SLD-CTHA, CTHA, angiography and triphasic spiral CT, but in HCCs of more than 4 cm, angiography, CTHA and SLD-CTHA detected hypervascularity equally well. Lesion size most affected the findings of angiography.

Safety of Superselective Transcatheter Arterial Chemoembolization through Cystic Artery for Treatment of Hepatocellular Carcinoma

PURPOSE: To report on the safety and efficacy of superselective transcatheter arterial chemoembolization( TACE) of tumor feeding branches originating from the cystic artery for the treatment of hepatocellular. MATERIALS AND METHODS: From, May 1995 to, September 1999, eleven HCC patients aged between 38 and 82 (mean, 57.4) years with tumor-feeding branches originating from the cystic artery underwent TACE. In eight, for whom superselection of these branches was possible, TACE was done with the use of Gelfoam and a mixture of Lipiodol and cisplatin, while for three, for whom superselection was impossible, a mixture of Lipiodol and cisplatin only was used. Immediately after TACE, remnant tumor staining was angiographically evaluated,and tumor response was determined by follow-up CT at one month. After procedure, the development of cholecystitis was assessed clinically. RESULTS: Post-TACE angiography showed remnant tumor staining in one patient who underwent embolization with Gelfoam and the mixture of Lipiodol and cisplatin, and in one for whom the mixture of Lipiodol & cisplatin only was used. Among the eight for whom Gelfoam and the mixture of Lipiodol and cisplatin was used,one-month follow-up CT showed compact Lipiodol uptake in five, partial Lipiodol uptake in three, no change in tumor size in six, increased tumor size in one, and decreased tumor size in one. Among the three for whom the mixture of Lipiodol and cisplatin only was used, one-month follow-up CT showed neither Lipiodol uptake nor change in tumor size in one patient, partial Lipiodol uptake and increased tumor size in one, and compact Lipiodol uptake and decreased tumor size in one. Cholecystitis developed in only one patient who underwent embolization with Gelfoam and the mixture of Lipiodol and cisplatin, but was cured by conservative treatment. CONCLUSION: Superselective TACE of tumor feeding branches originating from the cystic artery seems to be a safe and effective method for the treatment of hepatocellular carcinoma.

Morphologic Characteristics of Hepatocellular Carcinoma in Patients with more than 5 Year-Survival

PURPOSE: To determine which morphologic and radiologic characteristics and common features of HCC in patients with a survival time of more than five years are useful for prognosis and appropriate therapeutic modality. MATERIALS AND METHODS: Among 178 patients in whom HCC was diagnosed at our hospital and who underwent dynamic CT and angiography, we retrospectively reviewed the cases of 12 who survived more than five years. Initially, the gross finding, size, number, vascularity of HCC, and extent of portal vein invasion were analyzed. The presence of lymph node enlargement was investigated during follow-up study and in cases confirmed surgically, the results were compared with the histopathologic findings. The therapeutic modalities of the 12 patients were as follows; only surgical resection, 3 cases(1 case: re-operation); surgical resection with transarterial chemoembolization(TAE), 5 cases(1 case: re-operation); only TAE, 4 cases (1 case: combined with hollium in-jection); and at present, expiry after survival for more than five years, 3 cases; survival with disease, 3 cases and survival without disease, 6 cases(2 cases: re-operation after recurrence). RESULTS: In 12 patients who survived more than five years, initial gross classification was single nodular type in 11 cases and massive type in one case; all showed typical ypervascularity on dynamic CT and hepatic angiography. With regard to extent of portal vein invasion, two cases showed involvement of the lobar branch and in one case invasion of the segmental branch was noted. In the other nine cases there was either invasion of the distal small branch or no definite portal vein invasion. HCC size ranged from 2 to 10 (mean, 5)cm. In eight cases involving surgical resection (reoperation : two cases), the histopathologic findings indicated, pre-dominantly, the trabecular type and Edmondson grade II -III. The exception was one case of grade III -IV. In eight cases of single HCC at the time of diagnosis, multiple recurrent HCCs were present. In four cases tumors did not recur, and follow-up study revealed no lymph node enlargement. CONCLUSION: Initial radiologic findings [number of tumors (one only), gross classification (nodular type), vascu-larity(hypervascularity), portal vein invasion(lesser extent), histopathologic findings(predominantly trabecular type)] and the absence of lymph node enlargement are thought to be more important factors than tumor size in the prognosis of HCC. If initial examination of HCC reveals the above mentioned radiologic features, a more aggressive and active therapeutic management approach should be carefully considered.

Hepatic Cavernous Hemangioma in Cirrhotic Liver: Imaging Findings

OBJECTIVE: To document the imaging findings of hepatic cavernous heman-gioma detected in cirrhotic liver. MATERIALS AND METHODS: The imaging findings of 14 hepatic cavernous hemangiomas in ten patients with liver cirrhosis were retrospectively analyzed. A diagnosis of hepatic cavernous hemangioma was based on the findings of two or more of the following imaging studies: MR, including contrast-enhanced dynamic imaging (n = 10), dynamic CT (n = 4), hepatic arteriography (n = 9), and US (n =10). RESULTS: The mean size of the 14 hepatic hemangiomas was 0.9 (range, 0.5 -1.5) cm in the longest dimension. In 11 of these (79%), contrast-enhanced dynamic CT and MR imaging showed rapid contrast enhancement of the entire lesion during the early phase, and hepatic arteriography revealed globular enhancement and rapid filling-in. On contrast-enhanced MR images, three lesions (21%) showed partial enhancement until the 5-min delayed phases. US indicated that while three slowly enhancing lesions were homogeneously hypere-choic, 9 (82%) of 11 showing rapid enhancement were not delineated. CONCLUSION: The majority of hepatic cavernous hemangiomas detected in cirrhotic liver are small in size, and in many, hepatic arteriography and/or contrast-enhanced dynamic CT and MR imaging demonstrates rapid enhancement. US, however, fails to distinguish a lesion of this kind from its cirrhotic background.

Intraperitoneal Hemorrhage Due to Spontaneous Rupture of Hepatocellular Carcinoma: Comparisons of Tranarterial Oily Chemoembolization and Simple Embolization with Gelfoam

PURPOSE: To compare the safety and effectiveness of transarterial oily chemoembolization (TOCE) and transar-terial embolization (TAE) with Gelfoam in cases of ruptured hepatocellular carcinoma (HCC), and to describe the most important prognostic factors involved in emergency embolization. MATERIALS AND METHODS: Forty-two consecutive patients with spontaneously ruptured HCC underwent emergency TOCE (n = 22) or TGE (n = 20). In the TOCE group, Lipiodol (3 -10 cc), Adriamycin (20 -50 mg), and Mitomycin (2 -10 mg) were used, and these were followed by blockade of the hepatic arterial flow with gelatin sponge particles. In the TAE group, patients underwent only Gelfoam embolization. Using the Kaplan-Meier method, survival time from the time of embolization was estimated, and to analyze prognostic factors, Cox 's proportional hazard regression model was used. RESULTS: Successful hemostasis was achieved in 41 patients (97.6%). Mean survival time was 201 and 246 days in the TOCE and TAE group, respectively, but the difference was not tatistically significant (p > 0.05). Five of the TOCE group (22.7%) and three of the TAE group (15.0%) died of hepatic failure. Analysis of the prognostic factors showed that portal vein involvement by the tumor was the most important factor influencing survival. CONCLUSION: Although TOCE and TAE effectively controlled hemorrhaging from a ruptured HCC, the procedures involve a high risk of hepatic failure. Their goal should, therefore, be solely to achieve hemostasis, and thus decrease parenchymal injury.

Embolization of Seve re Arterioportal Shunts in the Patients with Hepatocellular Carcinoma: Safety and Influence on Patient Survival

PURPOSE: To evaluate the safety and the influence of embolization of severe arterioportal shunts, and the effect of the procedure on the survival rate of patients with hepatocellular carcinoma combined with portal vein tumor thrombosis. MATERIALS AND METHODS: This study involved a total of 54 patients with hepatocellular carcinoma in whom hepatic arteriography revealed severe arterioportal shunt. From among this total, 34 patients (embolization group) underwent chemoinfusion after shunt embolization, while 19 (control group) underwent chemoinfusion only. The embolic materials included PVA particles and/or Gelfoam pieces. The frequency of postembolization symptoms (Chi-squared test) and changes in laboratory values (paired t-test) were compared between the two groups, and shunt improvement was also evaluated. Patient survival was tested using the Kaplan-Meier method. RESULTS: Fever and RUQ pain were more frequent in the embolization group (p<0.001). The complications of embolization included severe postembolization syndrome (n=1), acute hepatic failure (n=2), hepatic infarction (n=1), and sepsis (n=1). There were no significant changes in laboratory values. Among the 28 patients (24 of embolization group and four of control group) who underwent follow-up angiography, arterioportal shunt became less severe or disappeared in ten of the embolization group. For the embolization and control groups, the mean survival interval was 29.5 +/-5.4 weeks and 10.3 +/-3.1 weeks (p=0.0002), respectively. The best results were seen in the PVA particle group (p=0.01). CONCLUSION: The embolization of severe arterioportal shunts is relatively safe and increases patient survival rate.

The Effect of Subsegmental Transcatheter Arterial Chemoembolization in Hepatocellular Carcinoma: PathologicCorrelation

PURPOSE: To assess the effectiveness of subsegmental transcatheter arterial chemoembolization(TAE) forhepatocellular carcinomas(HCCs) on the basis of tumor necrosis rate. MATERIAL AND METHODS: Between May 1996 andMarch 1998, ten patients with single HCC after subsegmental TAE underwent surgical resection. Subsegmental TAE wasperformed by injecting a mixture of lipiodol and adriamycin followed by gelatin sponge particles into the distalbranches of the subsegmental arteries. Tumor size and the extent of necrosis were analyzed in ten resectedlesions, and in all patients, complications after subsegmental TAE were assessed. RESULTS: The size of resectedtumors ranged from 1 to 5,5cm. On histological examination, complete necrosis was seen in 6 to 10 resected lesionsand 95% necrosis in three. In the remaining lesion, 85% necrosis had occured. Complete necrosis was noted in 4 of6 small HCCs(less than 3cm in diameter), while in the remaining two the extent of necrosis was 95%. Nocomplications were observed. CONCLUSION: For the treatment of HCC, subsegmental TAE is safe and effective.Curative therapy must, however, involve follow-up and repeated TAE.

Transcatheter Arterial Embolization of Ruptured Hepatocellular Carcinoma: Effectiveness and Long-term Follow-up

PURPOSE: To evaluate the effectiveness of emergent transcatheter arterial embolization(TAE) in the treatmentof bleeding from ruptured hepatocellular carcinoma(HCC) and long-term follow-up. MATERIALS AND METHODS: Twentypatients with ruptured HCC underwent emergent TAE; diagnosis was based on clinical and radiologic findings.Mesoportography was used to determine the presence of portal vein thrombosis, and celiac angiography to determinethe presence of hypervascular mass and extravasation of contrast material. All patients underwent TAE; a mixtureof adriamycin, mitomycin, lipiodol, and gelfoam particles was used. In four of the 20 patients, adjuvantembolization was performed, using stainless steel coils. After three week of follow-up CT, follow-up TAE wasperformed between two and ten times. RESULTS: Technical and clinical success was up to 100%. Mesoportographyshowed the presence of portal vein thrombosis in nine patients and its absence in 11. In 15 patients, three weeksof follow-up by CT showed lipiodol uptake by the mass and the disappearance of highly attenuated peritoneal fluid.Within one week of embolization, four of the 20 patients died of sepsis, shock, and hepatic failure, and withinone month of this procedure, one died of renal failure. Three-month, six-month, and one-year survival rates afterTAE were repectively 50%, 45%, and 30%; the mean duration of survival was 260 days. In nine patients with portalvein thrombosis, the one-year survival rate was 11%, while in 11 patients not suffering from this condition, therate was 70%; the difference between the two groups was statistically significant(p < 0.05). CONCLUSION: As thefirst choice of treatment for patients with hemoperitoneum from ruptured HCC, emergent TAE is an effective,life-saving therapeutic procedure; in these patients, portal vein thrombosis may be a factor influencing risk andprognosis.

Nodular Regenerative Hyperplasia of the Liver: Radiologic Findings

Nodular regenerative hyperplasia (NRH) of the liver is not common, and no MR imaging of this condition has been reported. We describe a case of NRH with findings of US, CT, MR and angiography. US showed hypoechoic nodules; spiral CT showed enhancing nodules during the arterial phase; MR showed no detectable masses on T1 and T2-weighted images, and angiography showed hypervascular masses on arterial phases.

Treatment of Single Nodular Hepatocellular Carcinoma Using Combination Methods of Percutaneous Ethanol Injection Therapy and Subsequent Transcatheter Arterial Chemoembolization

PURPOSE: To evaluate the usefulness of combination therapy composed of percutaneous ethanol injection treatment and subsequent transarterial chemoembolization in the treatment of single nodular hepatocellular carcinoma(HCC). MATERIALS AND METHODS: A total of eight patients with single nodule hepatocellur carcinoma (+/-5cm)were treated with a combination of initial percutaneous ethonol injection therapy(PEIT) and, a week later, transcatether arterial embolization(TAE). CT was performed 3 weeks after TAE to assess whether or not lipidol uptake had occurred. If lipiodol was accumulated in the nodule, the necrotic rate of the tumor was calculated by the following equation: (initially observed tumor volume - volume of nodule in which lipidol uptake occurred)x100/Initially observed tumor volume. Follow-up CT scan was performed every third or fourth month to evaluate tumor growth or recurrence. RESULTS: A nodule in which lipidol uptake occurred was seen in four of the eight patients; in one of these, a tumor-confirmed by angiogaphic examination and laboratory data-recurred twelve months later. The mean necrotic rate of a tumor treated PEIT alone was 83%(range, 37%-100%). CONCLUSION: Although limited in numbers of cases we studied, use of combination therapy composed of PEIT and subsequent TAE, appears to be effective in achieving the high rate of tumor necrosis as well as in the evaluation of the tumor during follow-up.

Imaging Findings of Adenomatous Hyperplasia of the Liver

PURPOSE: To determine the features of hepatic adenomatous hyperplasia using different imaging modalities. MATERIALS AND METHODS: Twenty-two patients with 29 adenomatous hyperplastic nodules of the liver (0.9-3.1 cm) underwent sonography (29 lesions), CT (24 lesions), angiography (11 lesions), MR (12 lesions), and Lipiodol CT(seven lesions). Each lesion was analyzed for echogenicity, attenuation, vascularity, signal intensity, and Lipiodol uptake. RESULTS: On sonograms, echogenicity was high in 16, low in 11, and iso- in 2 of 29 lesions. On contrast enhanced CT scans, attenuation was high in 4, low in 14, and iso- in 6 of 24 lesions. On hepatic angiograms, vascularity of lesions was avascular in 9 and slightly vascular in 2 of 11 lesions. On MR images, signal intensity was high in 11 and iso- in 1 of 12 lesions on T1-weighted MRI, and iso- in 7, and low in 5 of 12 lesions on T2-weighted MRI. On iodized-oil CT scans, retention of Lipiodol was present in 3 and absent in 4 of seven lesions. CONCLUSION: Common imaging findings of adenomatous hyperplasia of the liver are high echogenicity on sonography, low attenuation on CT, hypovascularity on angiography, high signal intensity on T1-weighted MRI, and iso- or low signal intensity on T2-weighted MRI.

Analysis of Prognostic Factors in Patients with Hepatocellular Carcinoma after Transcatheter Hepatic Arterial Chemoembolization(TAE)

PURPOSE: To evaluate long-term survival rates and prognostic factors of patients with hepatocellularcarcinoma after TAE. MATERIALS AND METHODS: 225 patients with hepatocellular carcinoma treated with TAE between January 1988 and December 1994 were studied. Hepatocellular carcinoma was diagnosed either histologically(n=13) orclinically on the basis of findings characteristic for hepatocellular carcinoma obtained using such as diagnostic imaging methods such as ultrasonography, CT, MRI, and angiography as well as on the basis of high serumalpha-fetoprotein level(n=212). TAE was carried out between one and six times(mean, 1.4 time) using a mixture of lipiodol and Adriamycin, together with Gelfoam. Cumulative survival rates from the day of the first TAE were obtained by the Kaplan-Meier method. Parameters likely to influence the prognosis were subjected to univariate analysis using the log-rank test RESULTS: Cumulative survival rates at the end of the first, second, third, fourth, and fifth year were 55.9%, 32.6%, 21.9%, 17.9%, and 15.0%, respectively. The mean survival time was 727+/-76 days. Several factors, including Child-Pugh classification, Okuda's stage, tumor size, presence of portalvein invasion by tumor, of arterio-portal shunt, and of extra hepatic metastases, catheter selection level, and number of TAE showed significant correlation with the outcome. Degrees of Lipiodol accumulation in a tumor onfollow up CT were also correlated with survival rates. CONCLUSION: TAE is an effective measure for prolonging the patient's life expectancy and evaluation of prognostic factor is helpful for prognosis and in deciding on the optimal therapeutic modality.

Comparison of Survival Rates among Different Treatment Methods of Transcatheter Hepatic Arterial Chemoembolization for hepatocellular Carcinoma

PURPOSE: To compare the survival rates of patients with hepatoma using different methods of transcatheter arterial chemoemblization(THAE). MATERIALS AND METHODS: Four hundred and eighty three patients with hepatoma diagnosed by biopsy, serum alpha-fetoprotein, abdominal CT scan, abdominal ultrasonography or hepatic angiography were included, but not all had reccived surgical treatment. They were divided into two groups according to Child's classification and into subgroups according to different methods of THAE. Five-year survival rates among these groups were retrospectively Compared. The patients were aged between 24 and 85(mean, 58) ; male to female ratio was 324:61 for those who received THAE (396:87 when only hepatic angiography was considered). RESULTS: In the group with more than a single episode of chemoembolization, regardless of Child's classification, a better survival rate compared to the other groups with or without concommitant radiotherapy or without chemoembolization was noted. There was no difference in the survival rate of patients with multiple chemoembolization. Moreover, no difference in this rate was observed no matter what chemotherapeutic agents, including Adriamycin, Cis-Diaminedichloroplatinum or 1-131-Lipiodol, were used. Embolization by gelfoam in conjuction with Adriamycin resulted in no difference in survival rate regardless of requency of chemoembolization. CONCLUSIONS: An improved survival rate was seen when multiple episodes of chemoembolization were applied, but no difference was seen when there was concomitant application of either gelfoam or radiotherapy. Two different chemotherapeutic agents,Adriamycin and Cis-Diaminedichloroplatinum, were used, but there was no difference between them in their effect on survival rates.

Primary Hepatic Leiomyosarcoma: A Case Report

Primary hepatic leiomyosarcoma is an extremely rare neoplasm, with fewer than 60 previously reported cases. Apatient was admitted with pain and palpable mass in the right upper abdomen. An ultrasonogram showed a largecystic mass with irregular thick wall in the right lobe of the liver. On a CT scan, the mass showed irregular enhancement along its wall, but central portion was not enhanced. A celiac angiogram revealed a large hypervascular mass with abundant abnormal vascularities in its peripheral portion. Right hepatectomy was undertaken, and histologic examination, revealed hepatic leiomyosarcoma.

Radiologic Characteristics of Hepatocellular Carcinoma with Intrabile Duct Tumor Growth and Extension

PURPOSE: To determine the radiologic characteristics of the hepatocellular carcinoma with intrabile ducttumor growth and extension. MATERIALS AND METHODS: We analyzed the arterial-dominant phase(ADP) CT scans, hepaticangiograms and cholangiograms in nine cases of hepatocellular carcinomas with intrabile duct tumor growth andextension confirmed by tumor thrombectomy. RESULTS: The gross types were nodular in three cases and massive infive. Two masses were larger than 6cm, four were between 3 and 6cm, and three were less than 3cm. Among six casesof ADP-CT scan, dense contrast enhancement was observed in four, minimal enhancement in one, and no enhancement inone. In one case we were unable to find a primary mass. With regard to tumor staining on hepatic arteriograms, five cases were hypervascular, one case was hypovascular, and the remaing one was not found. All tumor thrombi were seen as filling defects which were dilating the bile duct on cholangiograms. Among five intrabile ducttumors, thrombi were detected on ADP-CT scan(n=6), dense contrast enhancement was observed in one case, minimalenhancement in two cases and no enhancement in two cases. CONCLUSION: Intrabile duct tumor growth and extensionin hepatocellular carcinoma(HCC) does not correlate with location, mass size or tumor vascularity. It was concluded that tumor thrombi were formed through the direct invasion by a tumor of a branch of the intrahepaticduct, its growth in the distal direction in the biliary tree and subsequent extension to the common bile duct. Thrombi were more hypovascular than primary mass.