Triphasic spiral CT imaging of hepato-cellular carcinoma in the cirrhotic liver

ABSTRACT

Hepatocellular carcinoma [HCC] is responsible for a large proportion of cancer deaths worldwide and derives its blood supply predominantly from the hepatic artery. The imaging modalities used in diagnosis of HCC include ultrasound [US], multiphase spiral CT [MsCT], magnetic resonance imaging [MRI], angiography, positron emission tomography [PET], and imaging-guided biopsy. The aim of this study was to clarify the role of triphasic spiral CT in evaluation of patients with hepatocellular carcinoma developed on top of cirrhosis. This study included 30 male patients with evident cirrhosis and suspected clinically and/ or by real time ultrasonography [US] to have hepatocellular carcinoma [HCC]. All of them were subjected to the followings 1]-Full history taking and clinical examination.2]-Laboratory investigations including hepatic function tests and serum alfa-feto-protein level. 3]-Real time ultrasonography of the liver [US]. 4]-Triphasic spiral CT of the liver [TsCT]. 5]-Finally, the results were confirmed by CT-guided biopsy in 15 cases, US-guided biopsy in 10 cases, and follow up in the remaining 5 cases. The mean age of the studied patients was 57 years. Their commonest clinical presentation was right upper quadrant abdominal pain. All of them showed elevated liver function tests and the alfa-feto-protein level was elevated in 73.3% of these cases. All of the detected lesions were solid and/or predominantly solid on real time US study and 20/30[66.7%] lesions showed non-homogenous echo texture pattern. Their outlines were ill-defined in 20/30[66.7%] lesions and halo sign was noted in 15/30[50%] lesions. The lesions commonly affected the medial segment of left hepatic lobe in 12/30[40%] cases. On triphasic spiral CT [TsCT], the mean size of the examined lesions was 7.1cm. 15/30[50%] lesions showed faint, non-homogenous enhancement, 10/30[33.3%] lesions showed intense, and homogenous enhancement and 5/30[16.7%] showed peripheral enhancement on the arterial phase. 66.7% and 83.3% of the studied lesions appeared isodense compared with the adjacent cirrhotic hepatic parenchymal tissue on both portal venous and delayed phases. Associated findings included splenomegaly in 66.7% of the cases, ascites was noted in 20% of the patients and portal vein thrombosis was seen in 13.3% of the cases. Real time US is the preliminary imaging modality for evaluation of patients with suspected HCC on top of cirrhosis, as it gives a good idea about the morphological characteristics of these lesions. In addition, US-guided needle biopsy is frequently required for their diagnosis. Triphasic spiral CT is valuable for further characterization of these lesions, determination of their vascular supply and guides their percutaneous biopsy