CT Evaluation of the Progression of Hypoattenuating Nodular Lesions in Virus-Related Chronic Liver Disease
Kenichi Takayasu1,
Yukio Muramatsu2,
Yasunori Mizuguchi1,
Takuji Okusaka3,
Kazuaki Shimada4,
Tadatoshi Takayama4,5 and
Michiie Sakamoto6,7
1 Department of Diagnostic Radiology, National Cancer Center Hospital, 5-1-1,
Tsukiji, Chuo-ku, Tokyo 104-0045, Japan.
2 Cancer Screening Division, Research Center for Cancer Prevention and
Screening, National Cancer Center, Tsukiji, Chuo-ku, Tokyo 104-0045,
Japan.
3 Division of Hepatobiliary and Pancreatic Oncology, National Cancer Center
Hospital, Tokyo 104-0045, Japan.
4 Division of Hepatobiliary Surgery, National Cancer Center Hospital, Tokyo
104-0045, Japan.
5 Present address: Third Department of Surgery, Nihon University School of
Medicine, Tokyo, Japan.
6 Division of Pathology, National Cancer Center Research Institute, Tokyo
104-0045, Japan.
7 Present address: Department of Pathology, Keio University School of Medicine,
Tokyo 160-8582, Japan.
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Fig. 1A —66-year-old woman with hypoattenuating lesion that progressed
to hyper-in-hypoattenuating type (nodule-in-nodule hepatocellular carcinoma
[HCC]) (group B1) and advanced to complete hyperattenuation (overt HCC) (group
B2). Arterial phase CT scan shows 1.0-cm hypoattenuating lesion
(arrow) in segment II of liver.
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Fig. 1B —66-year-old woman with hypoattenuating lesion that progressed
to hyper-in-hypoattenuating type (nodule-in-nodule hepatocellular carcinoma
[HCC]) (group B1) and advanced to complete hyperattenuation (overt HCC) (group
B2). Delayed phase of A shows hypoattenuating lesion
(arrow).
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Fig. 1C —66-year-old woman with hypoattenuating lesion that progressed
to hyper-in-hypoattenuating type (nodule-in-nodule hepatocellular carcinoma
[HCC]) (group B1) and advanced to complete hyperattenuation (overt HCC) (group
B2). Follow-up arterial phase CT scan 2 years 8 months after A shows
hyperattenuating area measuring 1.0 cm within hypoattenuating lesion
(arrow) measuring 2.5 cm.
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Fig. 1D —66-year-old woman with hypoattenuating lesion that progressed
to hyper-in-hypoattenuating type (nodule-in-nodule hepatocellular carcinoma
[HCC]) (group B1) and advanced to complete hyperattenuation (overt HCC) (group
B2). Delayed phase of C shows entire shape as hypoattenuating lesion
(arrow).
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Fig. 1E —66-year-old woman with hypoattenuating lesion that progressed
to hyper-in-hypoattenuating type (nodule-in-nodule hepatocellular carcinoma
[HCC]) (group B1) and advanced to complete hyperattenuation (overt HCC) (group
B2). Arterial phase CT scan 8 months after C shows 3.0-cm lesion
(arrow) almost entirely occupied by hyperattenuating component.
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Fig. 1F —66-year-old woman with hypoattenuating lesion that progressed
to hyper-in-hypoattenuating type (nodule-in-nodule hepatocellular carcinoma
[HCC]) (group B1) and advanced to complete hyperattenuation (overt HCC) (group
B2). Delayed phase of E shows hypoattenuating component
(arrow) with ring enhancement around lesion.
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Fig. 2A —57-year-old man with hypoattenuating lesion and no change in
attenuation even with increase in tumor size (group A, unchanged type).
Arterial phase of initial CT scan shows simple cyst (arrowhead), but
lesion is not visible.
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Fig. 2B —57-year-old man with hypoattenuating lesion and no change in
attenuation even with increase in tumor size (group A, unchanged type).
Delayed phase of A shows simple cyst (arrowhead) and subtle
1.0-cm hypoattenuating lesion (arrow) in segment IV of liver.
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Fig. 2C —57-year-old man with hypoattenuating lesion and no change in
attenuation even with increase in tumor size (group A, unchanged type).
Arterial phase of last CT scan 3 years 10 months after A shows
hypoattenuating lesion (arrow) has grown to 2.5 cm.
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Fig. 2D —57-year-old man with hypoattenuating lesion and no change in
attenuation even with increase in tumor size (group A, unchanged type).
Delayed phase of C.
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Fig. 2E — 57-year-old man with hypoattenuating lesion and no change in
attenuation even with increase in tumor size (group A, unchanged type). CT
hepatic arteriogram obtained 1 day after C shows hypoattenuating lesion
(arrow) that appeared isoattenuating on CT scan during arterial
portography (not shown).
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Fig. 3 —Outcome of 60 hypoattenuating nodular lesions in 53 patients
on dynamic CT chronologically divided by different attenuation pattern. HCC =
hepatocellular carcinoma.
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Fig. 4A —56-year-old man with hypoattenuating lesion that progressed
to entirely hyperattenuating lesion (overt HCC) (group B2) without detection
of hyper-in-hypoattenuating type lesion (nodule-in-nodule HCC). Arterial phase
CT scan shows hypoattenuating 0.8-cm lesion (arrow) in segment VII
that was also hypoattenuating in delayed phase (not shown).
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Fig. 4B —56-year-old man with hypoattenuating lesion that progressed
to entirely hyperattenuating lesion (overt HCC) (group B2) without detection
of hyper-in-hypoattenuating type lesion (nodule-in-nodule HCC). 22nd follow-up
arterial phase CT scan 6 years after A shows lesion is
isoattenuating.
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Fig. 4C —56-year-old man with hypoattenuating lesion that progressed
to entirely hyperattenuating lesion (overt HCC) (group B2) without detection
of hyper-in-hypoattenuating type lesion (nodule-in-nodule HCC). Delayed phase
of B shows hypoattenuating mass (arrow) measuring 2.5 cm.
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Fig. 4D —56-year-old man with hypoattenuating lesion that progressed
to entirely hyperattenuating lesion (overt HCC) (group B2) without detection
of hyper-in-hypoattenuating type lesion (nodule-in-nodule HCC). Arterial phase
CT scan 6 months after B shows lesion (arrow) is entirely
hyperattenuating and measures 3.0 cm.
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Fig. 5 —Comparison of cumulative attenuation conversion rates for 57
hypoattenuating lesions (three lesions that regressed spontaneously were
excluded). Group A = unchanged attenuation (n = 21), Group B1 =
hyper-in-hypoattenuating type (n = 25), Group B2 = entirely
hyperattenuating type (n = 11), Group B3 = Group B1 lesions with
additional follow-up (n = 6). Cumulative attenuation conversion rates
of groups A, B1, and B2 were 0, 24.0%, and 27.3% at 1 year; 0, 60.0%, and
72.7% at 2 years; and 0, 80.0%, and 91.0% at 3 years. Cumulative attenuation
conversion rate from hyper-in-hypoattenuating to entirely hyperattenuating
type (group B3) was 83.3% at 1 year. Statistically significant difference was
seen between groups B3 and B1 and between groups B3 and B2 (p <
0.001). No significant difference was seen between groups B1 and B2.
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Copyright © 2006 by the American Roentgen Ray Society.
