Detection of Hepatocellular Carcinomas and Dysplastic Nodules in Cirrhotic Livers
Accuracy of Helical CT in Transplant Patients
Jae Hoon Lim1,
Chan Kyo Kim1,
Won Jae Lee1,
Cheol Keun Park2,
Kwang Cheol Koh3,
Seung Woon Paik3 and
Jae Won Joh4
1
Department of Radiology, Samsung Medical Center, Sungkyunkwan University
School of Medicine, 50 Ilwon-dong, Kangnam-ku, 135-710 Seoul, Korea.
2
Department of Diagnostic Pathology, Samsung Medical Center, Sungkyunkwan
University School of Medicine, Kangnam-ku, 135-710 Seoul, Korea.
3
Department of Gastroenterology, Samsung Medical Center, Sungkyunkwan
University School of Medicine, Kangnam-ku, 135-710 Seoul, Korea.
4
Department of General Surgery, Samsung Medical Center, Sungkyunkwan University
School of Medicine, Kangnam-ku, 135-710 Seoul, Korea.
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Fig. 1A. —48-year-old man with macronodular cirrhosis associated with
hepatitis B. Explanted liver disclosed nodular hepatocellular carcinoma, which
was seen on CT. Arterial phase CT scan shows ill-defined faintly enhancing
oval mass (arrows) in subcapsular portion of medial segment of left
hepatic lobe. Liver surface is serrated.
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Fig. 1B. —48-year-old man with macronodular cirrhosis associated with
hepatitis B. Explanted liver disclosed nodular hepatocellular carcinoma, which
was seen on CT. Portal venous phase CT scan shows ill-defined faint
heterogeneous bilobed mass (arrows).
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Fig. 1C. —48-year-old man with macronodular cirrhosis associated with
hepatitis B. Explanted liver disclosed nodular hepatocellular carcinoma, which
was seen on CT. Delayed phase CT scan shows ill-defined bilobed mass
(arrows) of low attenuation.
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Fig. 1D. —48-year-old man with macronodular cirrhosis associated with
hepatitis B. Explanted liver disclosed nodular hepatocellular carcinoma, which
was seen on CT. Transverse section through upper part of liver shows
dumbbell-shaped single nodular hepatocellular carcinoma (white
arrows) with perinodular extension (black arrow) at upper part
of medial segment of left hepatic lobe. Tumor was 5.0 x 4.5 x 3.5
cm, encapsulated, but necrotic because of preoperative chemoembolization.
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Fig. 2A. —58-year-old man with micro- and macronodular cirrhosis as a result
of hepatitis B. Explanted liver showed four hepatocellular carcinomas: one 2.0
x 2.0 cm and three 1.2 x 1.2 cm in diameter. There were also three
dysplastic nodules measuring 0.9-1.2 cm in diameter. Among these seven
nodules, only one hepatocellular carcinoma, measuring 2.0 x 2.0 cm, was
seen on CT. Arterial phase CT scan of upper part of liver shows well-defined
faintly enhancing round nodule (arrow) in subcapsular portion of
right lobe. Portal and delayed phase CT scans (not shown) disclosed no visible
nodule in same area as nodule in A that became isoattenuating to
hepatic parenchyma.
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Fig. 2B. —58-year-old man with micro- and macronodular cirrhosis as a result
of hepatitis B. Explanted liver showed four hepatocellular carcinomas: one 2.0
x 2.0 cm and three 1.2 x 1.2 cm in diameter. There were also three
dysplastic nodules measuring 0.9-1.2 cm in diameter. Among these seven
nodules, only one hepatocellular carcinoma, measuring 2.0 x 2.0 cm, was
seen on CT. Arterial phase CT scan obtained 3 cm below A shows no
definite mass. Note right branch of portal vein (arrow).
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Fig. 2C. —58-year-old man with micro- and macronodular cirrhosis as a result
of hepatitis B. Explanted liver showed four hepatocellular carcinomas: one 2.0
x 2.0 cm and three 1.2 x 1.2 cm in diameter. There were also three
dysplastic nodules measuring 0.9-1.2 cm in diameter. Among these seven
nodules, only one hepatocellular carcinoma, measuring 2.0 x 2.0 cm, was
seen on CT. Arterial phase CT scan through lower part of right hepatic lobe
shows very ill-defined suspiciously enhancing nodule at medial aspect
(arrow) that was prospectively thought to be hepatocellular
carcinoma. No hepatocellular carcinoma or dysplastic nodule was found in same
area in explanted liver; high-attenuation lesion was pseudolesion.
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Fig. 2D. —58-year-old man with micro- and macronodular cirrhosis as a result
of hepatitis B. Explanted liver showed four hepatocellular carcinomas: one 2.0
x 2.0 cm and three 1.2 x 1.2 cm in diameter. There were also three
dysplastic nodules measuring 0.9-1.2 cm in diameter. Among these seven
nodules, only one hepatocellular carcinoma, measuring 2.0 x 2.0 cm, was
seen on CT. Coronal section through right lobe of liver (photograph not in
true anatomic orientation) shows hepatocellular carcinoma with capsule
measuring 2.0 x 2.0 cm (open arrow). Note dysplastic nodule
(curved arrow) measuring 0.9 cm adjacent to hepatocellular carcinoma
and another dysplastic nodule measuring 0.8 cm (thin straight arrow).
For orientation, note right hepatic vein (thick straight arrow) and
descending branch of right portal vein (arrowheads).
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Fig. 2E. —58-year-old man with micro- and macronodular cirrhosis as a result
of hepatitis B. Explanted liver showed four hepatocellular carcinomas: one 2.0
x 2.0 cm and three 1.2 x 1.2 cm in diameter. There were also three
dysplastic nodules measuring 0.9-1.2 cm in diameter. Among these seven
nodules, only one hepatocellular carcinoma, measuring 2.0 x 2.0 cm, was
seen on CT. Coronal section through posterior part of right hepatic lobe 3 cm
posterior to D shows hepatocellular carcinoma measuring 1.2 x 1.2
cm in diameter (open arrow) and two dysplastic nodules measuring 0.8
cm in diameter (curved arrows). These three nodules were not visible
on CT.
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