Helical CT Screening for Hepatocellular Carcinoma in Patients with Cirrhosis: Frequency and Causes of False-Positive Interpretation
Giuseppe Brancatelli1,
Richard L. Baron1,2,
Mark S. Peterson1,3 and
Wallis Marsh4
1 Department of Radiology, University of Pittsburgh Medical Center, 200 Lothrop
St., Pittsburgh, PA 15213.
2 Present address: Department of Radiology, University of Chicago, MC 2026, 5841
S. Maryland Ave., Chicago, IL 60637.
3 Present address: Radiology Ltd., 3170 E. Fort Lowell Rd., Tucson, AZ
85716.
4 Department of Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA
15213.
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Fig. 1A. —68-year-old woman with flash-filling hemangioma that was
prospectively detected on helical CT as hepatocellular carcinoma.
Contrast-enhanced helical CT image obtained through liver during hepatic
arterial phase shows homogeneously enhancing lesion (arrowhead)
originally reported as suspicious for hepatocellular carcinoma. At this time,
lesion enhancement is closest to aortic blood pool.
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Fig. 1B. —68-year-old woman with flash-filling hemangioma that was
prospectively detected on helical CT as hepatocellular carcinoma. Helical CT
image obtained at same level as A during portal venous phase shows that
lesion (arrowhead) has decreased its enhancement slightly but remains
enhanced to similar degree as blood pool seen in vessels. In retrospect,
hepatocellular carcinoma would not remain as blood pool attenuation but would
exhibit washout phenomena either isoattenuating or hypoattenuating to
surrounding liver. Unenhanced CT scan (not shown) also showed lesion to be
isoattenuating with blood vessels.
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Fig. 2A. —65-year-old man with primary biliary cirrhosis and peliosis
hepatis. Contrast-enhanced helical CT image obtained through liver during
hepatic arterial phase shows several small, homogeneously enhancing lesions
(arrows). Multiple lesions were seen throughout remainder of liver as
well.
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Fig. 2B. —65-year-old man with primary biliary cirrhosis and peliosis
hepatis. Helical CT image obtained during portal venous phase at same level as
A shows that most lesions (arrows) are still
hyperattenuating.
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Fig. 3A. —45-year-old woman with benign regenerative nodule with
low-grade dysplastic changes prospectively detected as hepatocellular
carcinoma on helical CT. Unenhanced axial helical CT image fails to identify
any lesion.
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Fig. 3B. —45-year-old woman with benign regenerative nodule with
low-grade dysplastic changes prospectively detected as hepatocellular
carcinoma on helical CT. Contrast-enhanced helical CT image obtained at same
level as A during hepatic arterial phase shows homogeneously enhancing
large lesion (arrow) in right lobe.
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Fig. 3C. —45-year-old woman with benign regenerative nodule with
low-grade dysplastic changes prospectively detected as hepatocellular
carcinoma on helical CT. Helical CT image obtained at same level as A
during portal venous phase shows that contrast material washed out of lesion
(arrow), which has become predominately isoattenuating with liver and
hypoattenuating to blood pool.
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Fig. 4A. —58-year-old man with false-positive diagnosis of
hepatocellular carcinoma due to arterial phase contrast enhancement with no
cause detected at gross pathologic examination. Axial helical CT image
obtained during hepatic arterial phase reveals enhancing lesion
(arrow) in right lobe.
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Fig. 4B. —58-year-old man with false-positive diagnosis of
hepatocellular carcinoma due to arterial phase contrast enhancement with no
cause detected at gross pathologic examination. Helical CT image obtained at
same level as A during portal venous phase fails to identify lesion,
which has become isoattenuating with remainder of liver. At pathologic
evaluation, no gross abnormality could be found in this region for microscopic
examination.
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Fig. 5A. —51-year-old woman with hepatic focal fibrosis misdiagnosed as
hepatocellular carcinoma. Axial helical CT images obtained during hepatic
arterial (A) and portal venous (B) phases reveal multiple round,
hypoattenuating areas (arrows) in right and left liver lobes. This
finding simulated hypovascular mass and was originally misdiagnosed as
possible tumor.
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Fig. 5B. —51-year-old woman with hepatic focal fibrosis misdiagnosed as
hepatocellular carcinoma. Axial helical CT images obtained during hepatic
arterial (A) and portal venous (B) phases reveal multiple round,
hypoattenuating areas (arrows) in right and left liver lobes. This
finding simulated hypovascular mass and was originally misdiagnosed as
possible tumor.
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Fig. 6A. —60-year-old woman with trapped fluid at dome of liver
misdiagnosed as hepatocellular carcinoma. Initial helical CT image obtained
during portal venous phase reveals hypoattenuating area (arrow)
posteriorly at dome of liver.
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Fig. 6B. —60-year-old woman with trapped fluid at dome of liver
misdiagnosed as hepatocellular carcinoma. Axial helical CT image obtained
during portal venous phase 7 months after A shows increase in ascites
(A) (also seen elsewhere), allowing easy determination of cause of original
lesion.
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Fig. 7A. —42-year-old man with focal confluent fibrosis.
Contrast-enhanced helical CT images obtained through liver during hepatic
arterial phase at two adjacent levels show ill-defined enhancing lesions
(arrowheads), worrisome for hepatocellular carcinoma.
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Fig. 7B. —42-year-old man with focal confluent fibrosis.
Contrast-enhanced helical CT images obtained through liver during hepatic
arterial phase at two adjacent levels show ill-defined enhancing lesions
(arrowheads), worrisome for hepatocellular carcinoma.
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Fig. 7C. —42-year-old man with focal confluent fibrosis. Helical CT
images obtained during arterial phase at same levels as A and B
1 year later show that capsular retraction (arrow), distinctive mark
of focal confluent fibrosis, has developed in region of previously noted
enhancement, whereas hyperattenuating lesions are no longer seen.
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Fig. 7D. —42-year-old man with focal confluent fibrosis. Helical CT
images obtained during arterial phase at same levels as A and B
1 year later show that capsular retraction (arrow), distinctive mark
of focal confluent fibrosis, has developed in region of previously noted
enhancement, whereas hyperattenuating lesions are no longer seen.
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Fig. 8A. —53-year-old man with alcohol-induced cirrhosis and
hepatocellular carcinoma. Unenhanced axial helical CT image shows small tumor
(arrow) as nodule of similar attenuation to adjacent liver and of
greater attenuation than blood pool, as in portal vein.
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Fig. 8B. —53-year-old man with alcohol-induced cirrhosis and
hepatocellular carcinoma. Axial helical CT image obtained at same level as
A during hepatic arterial phase shows that tumor (arrow)
enhances homogeneously.
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Fig. 8C. —53-year-old man with alcohol-induced cirrhosis and
hepatocellular carcinoma. Axial helical CT image obtained at same level as
A and B during portal venous phase shows that tumor
(arrow) has significantly decreased its enhancement to be
isoattenuating again with liver and with substantially less enhancement than
blood pool, as in portal vein.
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Copyright © 2003 by the American Roentgen Ray Society.
