HOME HELP FEEDBACK SUBSCRIPTIONS ARCHIVE SEARCH TABLE OF CONTENTS		QUICK SEARCH:   [advanced] Author: Keyword(s): Year:  Vol:  Page:

This Article Figures Only Full Text Full Text (PDF) CME Test (opens in a new window) Submit a response Alert me when this article is cited Alert me when eLetters are posted Alert me if a correction is posted Citation Map Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by Baron, R. L. Articles by Peterson, M. S. Search for Related Content PubMed PubMed Citation Articles by Baron, R. L. Articles by Peterson, M. S. Related Collections Magnetic Resonance Imaging Computed Tomography Gastrointestinal Radiology

From the RSNA Refresher Courses

Screening the Cirrhotic Liver for Hepatocellular Carcinoma with CT and MR Imaging: Opportunities and Pitfalls¹

¹ From the Department of Radiology, University of Pittsburgh School of Medicine, 200 Lothrop St, Pittsburgh, PA 15213. Presented as a refresher course at the 2000 RSNA scientific assembly. Received March 9, 2001; revision requested April 20 and revision received May 16; accepted June 7. Address correspondence to R.L.B. (e-mail: baronrl@msx.upmc.edu).

The inherent distortion of the appearance of liver parenchyma by the underlying pathologic changes of cirrhosis can obscure and simulate malignancy at imaging. That hepatocellular carcinoma is the most common abdominal malignancy worldwide and occurs most often in patients with chronic liver disease and cirrhosis compounds this problem. Magnetic resonance (MR) imaging and, to a lesser extent, computed tomography (CT) can depict the underlying nodular and fibrotic changes in patients with cirrhosis, particularly when siderotic nodular regeneration is present. Application of state-of-the-art helical CT and MR imaging techniques has improved the ability to detect hepatocellular carcinoma in this population, but, even with these advances, fewer than 50% of small tumors are detected with either of these techniques in a screening population. Dynamic hepatic arterial-phase contrast material–enhanced imaging is essential with both CT and MR imaging to achieve even these levels of success. Benign lesions that simulate tumor tissue are encountered in many patients with cirrhosis and include focal fibrosis, infarcted regenerative nodules, arteriovenous shunts, hemangiomas, pseudoaneurysms, and focal transient hepatic enhancement. An awareness of the imaging characteristics of these lesions can help one avoid a mistaken diagnosis of hepatocellular carcinoma in many cases.

Index Terms: Liver, cirrhosis, 761.794 • Liver neoplasms, 761.323 • Liver neoplasms, CT, 761.12114 • Liver neoplasms, MR, 761.12141

This article has been cited by other articles:

				J. M. Willatt, H. K. Hussain, S. Adusumilli, and J. A. Marrero MR Imaging of Hepatocellular Carcinoma in the Cirrhotic Liver: Challenges and Controversies Radiology, May 1, 2008; 247(2): 311 - 330. [Abstract] [Full Text] [PDF]

				E. Quaia, M. D'Onofrio, P. Cabassa, F. Vecchiato, S. Caffarri, F. Pittiani, K. M. Wittkowski, and M. A. Cova Diagnostic Value of Hepatocellular Nodule Vascularity After Microbubble Injection for Characterizing Malignancy in Patients with Cirrhosis Am. J. Roentgenol., December 1, 2007; 189(6): 1474 - 1483. [Abstract] [Full Text] [PDF]

				S. H. Kim, J. M. Lee, Y. J. Kim, J. Y. Choi, G. H. Kim, H. Y. Lee, and B. I. Choi Detection of Hepatocellular Carcinoma on CT in Liver Transplant Candidates: Comparison of PACS Tile and Multisynchronized Stack Modes Am. J. Roentgenol., May 1, 2007; 188(5): 1337 - 1342. [Abstract] [Full Text] [PDF]

				M. M. Bittle and F. S. Chew Radiological Reasoning: Incidentally Discovered Liver Mass Am. J. Roentgenol., June 1, 2006; 186(6_Supplement_1): S434 - S441. [Abstract] [Full Text] [PDF]

				R. Iannaccone, A. Laghi, C. Catalano, P. Rossi, F. Mangiapane, T. Murakami, M. Hori, F. Piacentini, I. Nofroni, and R. Passariello Hepatocellular Carcinoma: Role of Unenhanced and Delayed Phase Multi-Detector Row Helical CT in Patients with Cirrhosis Radiology, February 1, 2005; 234(2): 460 - 467. [Abstract] [Full Text] [PDF]

				M. Kanematsu, S. Goshima, H. K. Hussain, T. D. Johnson, H. V. Nghiem, and I. R. Francis Does T2-weighted MR Imaging Really Add No Value in Detection and Characterization of Focal Lesions in Cirrhotic Liver? * Dr Hussain and colleagues respond: Radiology, February 1, 2005; 234(2): 638 - 640. [Full Text]

				H. K. Hussain, I. Syed, H. V. Nghiem, T. D. Johnson, R. C. Carlos, W. J. Weadock, and I. R. Francis T2-weighted MR Imaging in the Assessment of Cirrhotic Liver Radiology, March 1, 2004; 230(3): 637 - 644. [Abstract] [Full Text] [PDF]

				A. Laghi, R. Iannaccone, P. Rossi, I. Carbone, R. Ferrari, F. Mangiapane, I. Nofroni, and R. Passariello Hepatocellular Carcinoma: Detection with Triple-Phase Multi-Detector Row Helical CT in Patients with Chronic Hepatitis Radiology, February 1, 2003; 226(2): 543 - 549. [Abstract] [Full Text] [PDF]