EURORAD ESR

Case 14696

News from Egypt: schistosomiasis-associated hepatocellular carcinoma

Author(s)
Tonolini Massimo, MD.

"Luigi Sacco" University Hospital, Radiology Department; Via G.B. Grassi 74 20157 Milan, Italy; Email:mtonolini@sirm.org
 
Patient
male, 47 year(s)
 
 
  • Figure 1
    Ultrasound

    Ultrasound showed hypoechoic thrombosis (+) of the entire portal vein (caliber 1.5 cm) and main intrahepatic branches; hyperechoic, mildly inhomogeneous, liver enlargement consistent with chronic disease without frank...

     
    Area of Interest: Liver; Imaging Technique: Ultrasound; Procedure: Diagnostic procedure; Special Focus: Parasites;
     
     
  • Figure 2
    Multiphase contrast-enhanced CT
     

    Arterial-phase (a...c) images confirmed thrombosis (+) of portal trunk and main intrahepatic branches without appreciable vascularisation; no detectable hypervascular focal liver lesions.

     
    Area of Interest: Liver; Imaging Technique: CT; Procedure: Diagnostic procedure; Special Focus: Parasites;

    Arterial-phase (a...c) images confirmed thrombosis (+) of portal trunk and main intrahepatic branches without appreciable vascularisation; no detectable hypervascular focal liver lesions.

     
    Area of Interest: Liver; Imaging Technique: CT; Procedure: Diagnostic procedure; Special Focus: Parasites;

    Arterial-phase (a...c) images confirmed thrombosis (+) of portal trunk and main intrahepatic branches without appreciable vascularisation; an ill-defined hypoattenuating nonenhancing region (*) was seen in the 8th...

     
    Area of Interest: Liver; Imaging Technique: CT; Procedure: Diagnostic procedure; Special Focus: Parasites;

    Portal-venous (d,e) and equilibrium (f, g) phase images confirmed thrombosis (+) of main intrahepatic branches and dilated portal trunk; ill-defined hypoattenuating region (*) in the 8th liver segment; minimal ascites.

     
    Area of Interest: Liver; Imaging Technique: CT; Procedure: Diagnostic procedure; Special Focus: Parasites;

    Portal-venous (d,e) and equilibrium (f...g) phase images confirmed thrombosis (+) of main intrahepatic branches and dilated portal trunk; ill-defined hypoattenuating region (*) in the 8th liver segment; minimal...

     
    Area of Interest: Liver; Imaging Technique: CT; Procedure: Diagnostic procedure; Special Focus: Parasites;

    Portal-venous (d,e) and equilibrium (f, g) phase images confirmed thrombosis (+) of main intrahepatic branches and dilated portal trunk; ill-defined hypoattenuating region (*) in the 8th liver segment; minimal ascites.

     
    Area of Interest: Liver; Imaging Technique: CT; Procedure: Diagnostic procedure; Special Focus: Parasites;

    Portal-venous (d,e) and equilibrium (f, g) phase images confirmed thrombosis (+) of main intrahepatic branches and dilated portal trunk; ill-defined hypoattenuating region (*) in the 8th liver segment; minimal ascites.

     
    Area of Interest: Liver; Imaging Technique: CT; Procedure: Diagnostic procedure; Special Focus: Parasites;
     
     
  • Figure 3
    Liver MRI - T2- and diffusion-weighted images
     

    T2-weighted images (a...d) confirmed minimal ascites, extensive inhomogeneous portal thrombosis (+) and showed vast region of subtle hypersignal (*) occupying most of liver dome, centered in the 8th segment.

     
    Area of Interest: Liver; Imaging Technique: MR; Procedure: Diagnostic procedure; Special Focus: Parasites;

    T2-weighted images (a...d) confirmed minimal ascites, extensive inhomogeneous portal thrombosis (+) and showed vast region of subtle hypersignal (*) occupying most of liver dome, centered in the 8th segment.

     
    Area of Interest: Liver; Imaging Technique: MR; Procedure: Diagnostic procedure; Special Focus: Parasites;

    T2-weighted images (a...d) confirmed minimal ascites, extensive inhomogeneous portal thrombosis (+) and showed vast region of subtle hypersignal (*) occupying most of liver dome, centered in the 8th segment.

     
    Area of Interest: Liver; Imaging Technique: MR; Procedure: Diagnostic procedure; Special Focus: Parasites;

    T2-weighted images (a...d) confirmed minimal ascites, extensive inhomogeneous portal thrombosis (+) and showed vast region of subtle hypersignal (*) occupying most of liver dome, centered in the 8th segment.

     
    Area of Interest: Liver; Imaging Technique: MR; Procedure: Diagnostic procedure; Special Focus: Parasites;

    The vast, grossly wedge-abnormal region occupying most of liver dome showed visually increased signal intensity (*) on high (800) b-value diffusion-weighted imaging, with corresponding hypointensity on apparent...

     
    Area of Interest: Liver; Imaging Technique: MR; Procedure: Diagnostic procedure; Special Focus: Parasites;

    The vast, grossly wedge-abnormal region occupying most of liver dome showed visually increased signal intensity (*) on high (800) b-value diffusion-weighted imaging, with corresponding hypointensity on apparent...

     
    Area of Interest: Liver; Imaging Technique: MR; Procedure: Diagnostic procedure; Special Focus: Parasites;
     
     
  • Figure 4
    Liver MRI - Pre- and postcontrast T1-weighted images (Gd-EOB-DTPA)
     

    Precontrast T1-weighted images (a...c) confirmed vast, approximately wedge-shaped low-signal region (*) with poorly demarcated margins in the 8th segment, and showed strong hyperintensity (+) of main intrahepatic...

     
    Area of Interest: Liver; Imaging Technique: MR; Procedure: Diagnostic procedure; Special Focus: Parasites;

    Precontrast T1-weighted images (a...c) confirmed vast, approximately wedge-shaped low-signal region (*) with poorly demarcated margins in the 8th segment, and showed strong hyperintensity (+) of main intrahepatic...

     
    Area of Interest: Liver; Imaging Technique: MR; Procedure: Diagnostic procedure; Special Focus: Parasites;

    Precontrast T1-weighted images (a...c) confirmed vast, approximately wedge-shaped low-signal region (*) with poorly demarcated margins in the 8th segment, and showed strong hyperintensity (+) of main intrahepatic...

     
    Area of Interest: Liver; Imaging Technique: MR; Procedure: Diagnostic procedure; Special Focus: Parasites;

    Arterial-phase (e,f) images did not show hypervascularity of both vast intraparenchymal abnormal region (+) centered in the 8th liver segment, and portal thrombosis (+).

     
    Area of Interest: Liver; Imaging Technique: MR; Procedure: Diagnostic procedure; Special Focus: Parasites;

    Arterial-phase (e,f) images did not show hypervascularity of both vast intraparenchymal abnormal region (+) centered in the 8th liver segment, and portal thrombosis (+).

     
    Area of Interest: Liver; Imaging Technique: MR; Procedure: Diagnostic procedure; Special Focus: Parasites;

    Portal venous (f,g) and equilibrium (h) phases confirmed vast, poorly demarcated hypoenhancing liver region (+) centered in the 8th segment, associated with thrombosis (+) of main portal vein and intrahepatic branches.

     
    Area of Interest: Liver; Imaging Technique: MR; Procedure: Diagnostic procedure; Special Focus: Parasites;

    Portal venous (f,g) and equilibrium (h) phases confirmed vast, poorly demarcated hypoenhancing liver region (+) centered in the 8th segment, associated with thrombosis (+) of main portal vein and intrahepatic branches.

     
    Area of Interest: Liver; Imaging Technique: MR; Procedure: Diagnostic procedure; Special Focus: Parasites;

    Portal venous (f,g) and equilibrium (h,i) phases confirmed vast, poorly demarcated hypoenhancing liver region (+) centered in the 8th segment, associated with thrombosis (+) of main portal vein and intrahepatic branches.

     
    Area of Interest: Liver; Imaging Technique: MR; Procedure: Diagnostic procedure; Special Focus: Parasites;

    Portal venous (f,g) and equilibrium (h,i) phases confirmed vast, poorly demarcated hypoenhancing liver region (+) centered in the 8th segment, associated with thrombosis (+) of main portal vein and intrahepatic branches.

     
    Area of Interest: Liver; Imaging Technique: MR; Procedure: Diagnostic procedure; Special Focus: Parasites;

    Finally, delayed hepatocyte-specific phase acquisition showed absent epatocellular uptake of Gd-EOB-DTPA contrast in the extensive abnormal liver region (+) reflecting lack of functioning hepatocytes.

     
    Area of Interest: Liver; Imaging Technique: MR; Procedure: Diagnostic procedure; Special Focus: Parasites;
     
     
Ultrasound showed hypoechoic thrombosis (+) of the entire portal vein (caliber 1.5 cm) and main intrahepatic branches; hyperechoic, mildly inhomogeneous, liver enlargement consistent with chronic disease without frank focal lesions.
 
Arterial-phase (a...c) images confirmed thrombosis (+) of portal trunk and main intrahepatic branches without appreciable vascularisation; no detectable hypervascular focal liver lesions.
 
Arterial-phase (a...c) images confirmed thrombosis (+) of portal trunk and main intrahepatic branches without appreciable vascularisation; no detectable hypervascular focal liver lesions.
 
Arterial-phase (a...c) images confirmed thrombosis (+) of portal trunk and main intrahepatic branches without appreciable vascularisation; an ill-defined hypoattenuating nonenhancing region (*) was seen in the 8th liver segment; note minimal ascites.
 
Portal-venous (d,e) and equilibrium (f, g) phase images confirmed thrombosis (+) of main intrahepatic branches and dilated portal trunk; ill-defined hypoattenuating region (*) in the 8th liver segment; minimal ascites.
 
Portal-venous (d,e) and equilibrium (f...g) phase images confirmed thrombosis (+) of main intrahepatic branches and dilated portal trunk; ill-defined hypoattenuating region (*) in the 8th liver segment; minimal ascites.
 
Portal-venous (d,e) and equilibrium (f, g) phase images confirmed thrombosis (+) of main intrahepatic branches and dilated portal trunk; ill-defined hypoattenuating region (*) in the 8th liver segment; minimal ascites.
 
Portal-venous (d,e) and equilibrium (f, g) phase images confirmed thrombosis (+) of main intrahepatic branches and dilated portal trunk; ill-defined hypoattenuating region (*) in the 8th liver segment; minimal ascites.
 
T2-weighted images (a...d) confirmed minimal ascites, extensive inhomogeneous portal thrombosis (+) and showed vast region of subtle hypersignal (*) occupying most of liver dome, centered in the 8th segment.
 
T2-weighted images (a...d) confirmed minimal ascites, extensive inhomogeneous portal thrombosis (+) and showed vast region of subtle hypersignal (*) occupying most of liver dome, centered in the 8th segment.
 
T2-weighted images (a...d) confirmed minimal ascites, extensive inhomogeneous portal thrombosis (+) and showed vast region of subtle hypersignal (*) occupying most of liver dome, centered in the 8th segment.
 
T2-weighted images (a...d) confirmed minimal ascites, extensive inhomogeneous portal thrombosis (+) and showed vast region of subtle hypersignal (*) occupying most of liver dome, centered in the 8th segment.
 
The vast, grossly wedge-abnormal region occupying most of liver dome showed visually increased signal intensity (*) on high (800) b-value diffusion-weighted imaging, with corresponding hypointensity on apparent diffusion coefficient map (f) reflecting restricted diffusion.
 
The vast, grossly wedge-abnormal region occupying most of liver dome showed visually increased signal intensity (*) on high (800) b-value diffusion-weighted imaging, with corresponding hypointensity on apparent diffusion coefficient map (f) reflecting restricted diffusion.
 
Precontrast T1-weighted images (a...c) confirmed vast, approximately wedge-shaped low-signal region (*) with poorly demarcated margins in the 8th segment, and showed strong hyperintensity (+) of main intrahepatic branches and dilated portal trunk suggesting recent thrombosis.
 
Precontrast T1-weighted images (a...c) confirmed vast, approximately wedge-shaped low-signal region (*) with poorly demarcated margins in the 8th segment, and showed strong hyperintensity (+) of main intrahepatic branches and dilated portal trunk suggesting recent thrombosis.
 
Precontrast T1-weighted images (a...c) confirmed vast, approximately wedge-shaped low-signal region (*) with poorly demarcated margins in the 8th segment, and showed strong hyperintensity (+) of main intrahepatic branches and dilated portal trunk suggesting recent thrombosis.
 
Arterial-phase (e,f) images did not show hypervascularity of both vast intraparenchymal abnormal region (+) centered in the 8th liver segment, and portal thrombosis (+).
 
Arterial-phase (e,f) images did not show hypervascularity of both vast intraparenchymal abnormal region (+) centered in the 8th liver segment, and portal thrombosis (+).
 
Portal venous (f,g) and equilibrium (h) phases confirmed vast, poorly demarcated hypoenhancing liver region (+) centered in the 8th segment, associated with thrombosis (+) of main portal vein and intrahepatic branches.
 
Portal venous (f,g) and equilibrium (h) phases confirmed vast, poorly demarcated hypoenhancing liver region (+) centered in the 8th segment, associated with thrombosis (+) of main portal vein and intrahepatic branches.
 
Portal venous (f,g) and equilibrium (h,i) phases confirmed vast, poorly demarcated hypoenhancing liver region (+) centered in the 8th segment, associated with thrombosis (+) of main portal vein and intrahepatic branches.
 
Portal venous (f,g) and equilibrium (h,i) phases confirmed vast, poorly demarcated hypoenhancing liver region (+) centered in the 8th segment, associated with thrombosis (+) of main portal vein and intrahepatic branches.
 
Finally, delayed hepatocyte-specific phase acquisition showed absent epatocellular uptake of Gd-EOB-DTPA contrast in the extensive abnormal liver region (+) reflecting lack of functioning hepatocytes.
 
 
 
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