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Hepatocellular Carcinoma in Cirrhotic Livers: Double-Contrast Thin-Section MR Imaging with Pathologic Correlation of Explanted Tissue

¹ All authors: Department of Clinical Radiology, St. James's University Hospital, Beckett St., Leeds LS9 7TF, United Kingdom.

View larger version (160K): [in a new window]   Fig. 1A. —Solitary hepatocellular carcinoma in 64-year-old man with cirrhotic liver. Unenhanced T1-weighted gradient-recalled echo MR image reveals faintly hyperintense area (arrow) in right lobe of liver.

View larger version (141K): [in a new window]   Fig. 1B. —Solitary hepatocellular carcinoma in 64-year-old man with cirrhotic liver. Unenhanced T2-weighted fast spin-echo MR image also shows poorly defined area of increased signal (arrow) in right lobe.

View larger version (138K): [in a new window]   Fig. 1C. —Solitary hepatocellular carcinoma in 64-year-old man with cirrhotic liver. On superparamagnetic iron oxide-enhanced T2-weighted gradient-recalled echo MR image, tumor is much more conspicuous because it has not taken up superparamagnetic iron oxide.

View larger version (133K): [in a new window]   Fig. 1D. —Solitary hepatocellular carcinoma in 64-year-old man with cirrhotic liver. Three-dimensional T1-weighted gradient-recalled echo MR image obtained during arterial phase 10 sec after gadolinium injection shows marked tumor enhancement.

View larger version (125K): [in a new window]   Fig. 1E. —Solitary hepatocellular carcinoma in 64-year-old man with cirrhotic liver. Three-dimensional T1-weighted gradient-recalled echo MR image obtained during portal venous phase 40 sec after gadolinium injection shows rapid washout of contrast material, resulting in visualization of only thin capsule around tumor.

View larger version (132K): [in a new window]   Fig. 2A. —50-year-old man with cirrhotic liver and multiple hepatocellular carcinomas. Unenhanced T1-weighted gradient-recalled echo MR image reveals small hyperintense tumor (arrow) in segment IV, which is suggestive of dysplastic nodule.

View larger version (142K): [in a new window]   Fig. 2B. —50-year-old man with cirrhotic liver and multiple hepatocellular carcinomas. Unenhanced T2-weighted fast spin-echo MR image shows small hypointense tumor (arrow) in segment IV, which is also suggestive of dysplastic nodule.

View larger version (138K): [in a new window]   Fig. 2C. —50-year-old man with cirrhotic liver and multiple hepatocellular carcinomas. On superparamagnetic iron oxide-enhanced T2-weighted gradient-recalled echo MR image, lesion (long arrow) in segment IV does not take up superparamagnetic iron oxide and therefore was correctly diagnosed as hepatocellular carcinoma. Additional 10-mm hepatocellular carcinoma (short arrow) was also revealed in segment VI of liver.

View larger version (149K): [in a new window]   Fig. 2D. —50-year-old man with cirrhotic liver and multiple hepatocellular carcinomas. Three-dimensional T1-weighted gradient-recalled echo MR image obtained 10 sec after gadolinium injection shows hypervascular hepatocellular carcinoma (arrow) in segment VI of liver. Hepatocellular carcinoma lesion in segment IV is isointense; therefore, it is likely that this tumor would have been wrongly diagnosed as dysplastic nodule if only unenhanced and dynamic gadolinium-enhanced images had been obtained.

View larger version (139K): [in a new window]   Fig. 3A. —False-positive lesion in 63-year-old man with cirrhotic liver. Three-dimensional T1-weighted gradient-recalled echo MR image obtained 10 sec after gadolinium injection shows hypervascular nodule (arrow) that was not identified on unenhanced or superparamagnetic iron oxide-enhanced MR images (not shown). No tumor was found on pathologic examination of explanted liver.

View larger version (138K): [in a new window]   Fig. 3B. —False-positive lesion in 63-year-old man with cirrhotic liver. Three-dimensional T1-weighted gradient-recalled echo MR image obtained during same sequence as A at more caudal level reveals another hypervascular nodule (arrow) that was not identified on unenhanced or superparamagnetic iron oxide-enhanced MR images (not shown). No tumor was found at pathologic examination of explanted liver.

View larger version (128K): [in a new window]   Fig. 4A. —Possible false-positive lesion in 63-year-old man with cirrhotic liver. Superparamagnetic iron oxide-enhanced T2-weighted gradient-recalled echo MR image shows subcentimeter nodule (arrow) located just below liver capsule in segment VI with no superparamagnetic iron oxide uptake.

View larger version (118K): [in a new window]   Fig. 4B. —Possible false-positive lesion in 63-year-old man with cirrhotic liver. Three-dimensional T1-weighted gradient-recalled echo MR image obtained 10 sec after gadolinium injection at same level as A shows nodule (arrow) is hypervascular during arterial phase. This lesion was only one to show imaging features typical of hepatocellular carcinoma that was found not to be carcinoma at pathology.

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