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Imaging in the Diagnosis, Staging, Treatment, and Surveillance of Hepatocellular Carcinoma

¹ All authors: Division of Diagnostic Imaging, The University of Texas M. D. Anderson Cancer Center, 1515 Holcombe Blvd., Box 57, Houston, TX 77030-4009.

View larger version (84K): [in a new window]   Fig. 1A. —Staging of primary tumors. Illustrations show solitary tumors 2 cm without (stage T1) (A) and with (stage T2a) (B) vascular invasion.

View larger version (85K): [in a new window]   Fig. 1B. —Staging of primary tumors. Illustrations show solitary tumors 2 cm without (stage T1) (A) and with (stage T2a) (B) vascular invasion.

View larger version (83K): [in a new window]   Fig. 1C. —Staging of primary tumors. Illustration shows multiple tumors 2 cm that are limited to one lobe with no vascular invasion (stage T2b).

View larger version (86K): [in a new window]   Fig. 1D. —Staging of primary tumors. Illustrations show solitary tumors >2 cm without (stage T2c) (D) and with (stage T3a) (E) vascular invasion.

View larger version (77K): [in a new window]   Fig. 1E. —Staging of primary tumors. Illustrations show solitary tumors >2 cm without (stage T2c) (D) and with (stage T3a) (E) vascular invasion.

View larger version (81K): [in a new window]   Fig. 1F. —Staging of primary tumors. Illustration shows multiple tumors 2 cm limited to one lobe with vascular invasion (stage T3b).

View larger version (87K): [in a new window]   Fig. 1G. —Staging of primary tumors. Illustration shows multiple tumors >2 cm with or without vascular invasion (stage T3c).

View larger version (81K): [in a new window]   Fig. 1H. —Staging of primary tumors. Illustration shows multiple tumors in more than one lobe (stage T4a).

View larger version (86K): [in a new window]   Fig. 1I. —Staging of primary tumors. Illustration shows multiple tumors with invasion of major branch of hepatic or portal vein or of adjacent organs other than gallbladder.

View larger version (83K): [in a new window]   Fig. 1J. —Staging of primary tumors. Illustration shows segmental anatomy of liver.

View larger version (147K): [in a new window]   Fig. 2. —79-year-old man who underwent hepatic resection for hepatocellular carcinoma and tested positive for hepatitis D antibody. Chest radiograph shows bilateral pulmonary metastases.

View larger version (150K): [in a new window]   Fig. 3. —50-year-old man with history of cirrhosis and hepatitis B and C. Transverse sonogram shows hypoechoic mass (arrow) in right lobe of liver.

View larger version (136K): [in a new window]   Fig. 4. —61-year-old man with metastatic hepatocellular carcinoma. Transverse sonogram of liver with sonographically guided biopsy shows hyperechoic mass with hypoechoic capsule (arrow) in right lobe of liver. Echogenic needle (arrowhead) is visualized.

View larger version (147K): [in a new window]   Fig. 5A. —50-year-old man with history of cirrhosis and hepatitis B and C. Transverse color Doppler sonogram of right upper quadrant shows flow of middle hepatic vein (white arrow), no flow in right hepatic vein (arrowhead), and echogenic thrombus in inferior vena cava (black arrow).

View larger version (60K): [in a new window]   Fig. 5B. —50-year-old man with history of cirrhosis and hepatitis B and C. Transverse color Doppler sonogram of right upper quadrant shows flow in right main portal vein (arrow). Normal spectral waveform (arrowhead) is also shown.

View larger version (118K): [in a new window]   Fig. 6. —48-year-old woman with serology findings negative for hepatitis and no history of alcohol abuse. Unenhanced CT scan of abdomen shows multiple low-attenuation bilobar masses.

View larger version (113K): [in a new window]   Fig. 7A. —74-year-old man with cirrhosis and history of alcohol exposure. Unenhanced CT scan of liver shows exophytic mass (arrow) on segment VII.

View larger version (141K): [in a new window]   Fig. 7B. —74-year-old man with cirrhosis and history of alcohol exposure. Contrast-enhanced CT scan of liver during late arterial phase shows multiple enhancing masses (arrows).

View larger version (140K): [in a new window]   Fig. 7C. —74-year-old man with cirrhosis and history of alcohol exposure. Contrast-enhanced CT scan of liver during venous delayed phase of enhancement shows decreased contrast between lesion and liver.

View larger version (128K): [in a new window]   Fig. 8A. —Axial CT scans of abdomen in 58-year-old man with hepatitis B. Image obtained during late arterial phase of enhancement shows faint mass (arrow) in liver segment VII.

View larger version (85K): [in a new window]   Fig. 8B. —Axial CT scans of abdomen in 58-year-old man with hepatitis B. Image obtained during delayed phase of contrast enhancement shows increase in contrast (arrow) between low-attenuation hepatocellular carcinoma and liver parenchyma.

View larger version (125K): [in a new window]   Fig. 9. —46-year-old man with hepatitis B. CT angiogram of liver during portal phase after direct infusion of contrast material into superior mesenteric artery shows low-attenuation hepatoma (white arrow). Spleen (black arrow) is also low in attenuation with respect to liver.

View larger version (132K): [in a new window]   Fig. 10. —50-year-old man with history of hepatitis B and C, cirrhosis, and portal hypertension. Delayed phase contrast-enhanced CT scan of liver shows thrombus (white arrow) in proximal inferior vena cava. Primary tumor (black arrow) is in segment VIII.

View larger version (145K): [in a new window]   Fig. 11A. —69-year-old man with alcohol cirrhosis. Arterial phase contrast-enhanced CT scan of abdomen at level of main portal vein shows linear enhancement of portal vein and ascites (arrow).

View larger version (141K): [in a new window]   Fig. 11B. —69-year-old man with alcohol cirrhosis. Late phase contrast-enhanced CT scan of abdomen at same level as A shows washout of enhancement in portal vein (arrow).

View larger version (136K): [in a new window]   Fig. 12. —51-year-old man with history of hepatitis C, cirrhosis, and hemochromatosis. Delayed phase contrast-enhanced CT scan of abdomen shows filling defect (arrow) in main portal vein. Note nodular contour of liver that is consistent with cirrhosis.

View larger version (102K): [in a new window]   Fig. 13. —76-year-old woman with history of left hepatic lobectomy. Delayed contrast-enhanced CT scan of abdomen shows recurrence of tumor (arrow) adjacent to surgical margin.

View larger version (157K): [in a new window]   Fig. 14A. —50-year-old man with history of hepatitis B and C and cirrhosis. Patient also had history of solid mass in lateral segment of left lobe of liver. Delayed phase contrast-enhanced CT scans of abdomen obtained 5 days (A) and 5 months (B) after radiofrequency ablation. Both images show change in size and attenuation of treated area (arrows) in lateral segment of left lobe of liver.

View larger version (147K): [in a new window]   Fig. 14B. —50-year-old man with history of hepatitis B and C and cirrhosis. Patient also had history of solid mass in lateral segment of left lobe of liver. Delayed phase contrast-enhanced CT scans of abdomen obtained 5 days (A) and 5 months (B) after radiofrequency ablation. Both images show change in size and attenuation of treated area (arrows) in lateral segment of left lobe of liver.

View larger version (149K): [in a new window]   Fig. 15A. —52-year-old man with history of hepatitis B and C. Axial two-dimensional spoiled gradient-echo unenhanced MR image (TR/TE, 4.1/110) shows faint hyperdense nodules (arrow) in right lobe of liver.

View larger version (142K): [in a new window]   Fig. 15B. —52-year-old man with history of hepatitis B and C. MR image from same sequence as A during early phase of enhancement shows marked enhancement of nodule (arrow) in segment VII.

View larger version (142K): [in a new window]   Fig. 16A. —74-year-old man with history of alcohol exposure. Axial spin-echo T1-weighted MR image of liver (TR/TE, 600/8) without IV contrast material shows low-signal-intensity mass (arrow) in segment V of liver.

View larger version (119K): [in a new window]   Fig. 16B. —74-year-old man with history of alcohol exposure. Axial fast spin-echo T2-weighted MR image (136/68; echo-train length, 12) shows hyperintense hepatocellular carcinoma (arrow).

View larger version (135K): [in a new window]   Fig. 16C. —74-year-old man with history of alcohol exposure. Axial spin-echo T1-weighted MR image of liver (600/8) after administration of mangafodipir (Teslascan; Nycomed-Amersham, Oslo, Norway) shows uptake of contrast material, which suggests moderately to well-differentiated tumor (arrow).

View larger version (146K): [in a new window]   Fig. 17A. —73-year-old man with hepatitis C and cirrhosis. Axial fast spin-echo T2-weighted MR image (TR/TE, 136/68; echo-train length, 12) of liver shows tumor to be slightly hyperintense. Note thin low-signal-intensity capsule (arrow).

View larger version (134K): [in a new window]   Fig. 17B. —73-year-old man with hepatitis C and cirrhosis. Delayed fat-saturated gadolinium-enhanced axial spin-echo T1-weighted MR image (TR/TE, 600/9) shows that hepatocellular carcinoma has low signal relative to liver. Note enhancing capsule (arrow).

View larger version (117K): [in a new window]   Fig. 18. —72-year-old man with history of hepatitis C and cirrhosis. Axial gradient-echo MR image (TR/TE, 110/4.1) during venous phase of enhancement after dynamic administration of gadolinium shows filling defect (arrow) in main left portal vein.

View larger version (133K): [in a new window]   Fig. 19. —61-year-old man with history of hepatitis B and cirrhosis. Axial time-of-flight gradient-echo MR image (TR/TE, 50/4) of liver during arterial phase of contrast enhancement shows filling defect (arrow) in inferior vena cava.

View larger version (133K): [in a new window]   Fig. 20A. —61-year-old man with serology findings negative for hepatitis B or C and no history of alcohol abuse. Arterial phase contrast-enhanced CT scan shows mass (arrow) in liver segment VII.

View larger version (134K): [in a new window]   Fig. 20B. —61-year-old man with serology findings negative for hepatitis B or C and no history of alcohol abuse. Delayed phase contrast-enhanced CT scans show coils (arrow, B) used in portal vein embolization (B), hypertrophy (arrow, C) of left lobe of liver, and changes after trisegmentectomy (C).

View larger version (116K): [in a new window]   Fig. 20C. —61-year-old man with serology findings negative for hepatitis B or C and no history of alcohol abuse. Delayed phase contrast-enhanced CT scans show coils (arrow, B) used in portal vein embolization (B), hypertrophy (arrow, C) of left lobe of liver, and changes after trisegmentectomy (C).

View larger version (108K): [in a new window]   Fig. 21. —61-year-old man with history of alcohol liver cirrhosis. Selected image from digital subtraction angiography of right hepatic artery (white arrow) shows catheter (black arrow) used for transarterial chemoembolization of tumor (arrowhead) in right lobe of liver.

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