CASE 190 Published on 28.01.2002
0

Hepatocarcinoma (HCC)

Section

Abdominal imaging

Case Type

Clinical Cases

Authors

Bassetti E,Trenna S, Paolantonio P, Iafrate F, Pacella S,

Connected authors
Patient

50 years, male

Categories
No Area of Interest ; Imaging Technique MR, MR, MR, MR
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Clinical History
Cirrhosis, HCC
Imaging Findings
Patient with liver cirrhosis (Child C) was admitted to our hospital with suspect of hepatocellular carcinoma (HCC) based on high blood level of Alpha-fetoprotein.
Discussion
In the Western world 80% of patients with HCC have underlying cirrhosis that is usually due to hepatitis or alcohol induced liver disease. Accurate detection of HCCs is critical in the follow up of patients with cronic hepatitis and liver cirrhosis. The main difficulty for diagnosis and staging of HCC consist in the detection of small HCC nodules (1). For detection of liver lesions usually spiral CT and MR are used and there are three important phases of ehnancement (arterial, portal venous and delayed phases). MR imaging is thought to be superior to helical CT for the detecion of HCC in patients with chronic liver damage (1, 2). Although large HCCs have unique imaging characteristics, some HCCs (15% ) are isointense with parenchyma in T1w and in T2w images (3). Dynamic imaging techniques (MR and CT) with a bolus injection of contrast have a fundamental role in detection of HCC (1). This case is an excellent example in which we underline the role of the early arterial phase in the evaluation of HCC.
Differential Diagnosis List
Multifocal HCC in cronic liver disease
Final Diagnosis
Multifocal HCC in cronic liver disease
Case information
URL: https://www.eurorad.org/case/190
DOI: 10.1594/EURORAD/CASE.190
ISSN: 1563-4086
Figure 1

MR HASTE T2w image

MR HASTE T2w image
Cirrotic liver with presence of fluid effusion localized in the peri- hepatic and peri-splenic spaces
MR HASTE T2w image
Cirrotic liver with presence of fluid effusion localized in the peri- hepatic and peri-splenic spaces
Figure 2

MR GRE T1w image

MR GRE T1w image
Cirrotic liver with presence of fluid effusion localized in the peri-hepatic and peri-splenic spaces
MR GRE T1w image
Cirrotic liver with presence of fluid effusion localized in the peri-hepatic and peri-splenic spaces
Figure 3

MR GRE contrast enhanced T1w image

MR GRE contrast enhanced T1w image
In the arterial phase is possible to evaluate multiple hyperintense nodules localized at the level of the VIII segment of the liver
MR GRE contrast enhanced T1w image
Nodules at the level of the VII segment of the liver
MR GRE contrast enhanced T1w image
Presence of a nodular formation also at the level of the VI segment of the liver
Figure 4

MR GRE contrast enhanced T1w image

MR GRE contrast enhanced T1w image
In this image and in this post contrast phase the lesions are not well evaluated as in the arterious one
MR GRE contrast enhanced T1w image
In this image and in this post contrast phase the lesions are not well evaluated as in the arterious one