[Full Text]. Pooled analysis demonstrated a sensitivity of 81% and a specificity of 85%. 6) with distension of the vein[30]. Liver PCT has generally been performed for a single slice through the liver; however, high temporal resolution of volume helical shuttle (VHS) scanning enables whole liver perfusion imaging with multiple sections[39]. [QxMD MEDLINE Link]. Venkatesh SK, Yin M, Glockner JF, et al. Dynamic contrast-enhanced, multiphasic MRI and MDCT are the most effective techniques for detection and staging. Hepatology. Management of hepatocellular carcinoma. Summary MRI findings vary for each form of local-regional treatment for hepatocellular carcinoma, particularly radiation therapies, and thus an understanding of [40] (Open Table in a new window). 9(2):225-34. 72 (9):2550-9. 4), vascular invasion (Fig. Hepatology. Tumor size predicts vascular invasion and histologic grade: Implications for selection of surgical treatment for hepatocellular carcinoma. The Barcelona approach: diagnosis, staging, and treatment of hepatocellular carcinoma. Zhu AX, Holalkere NS, Muzihansky A, Horgan K, Sahani DV. The higher sensitivity of MRI over CT is mostly due to the T2-weighted images; complete ablation would result in hypointensity with viable tumor appearing hyperintense[100]. As in the smaller lesions, there is a significant false-negative result rate, and close follow-up is indicated in patients with a negative biopsy result. Diabetes increases the risk of hepatocellular carcinoma in the United States: a population based case control study. Semin Liver Dis. Phase 3 randomized, open-label, multicenter study of tremelimumab and durvalumab as first-line therapy in patients with unresectable hepatocellular carcinoma: HIMALAYA. Adami HO, Hunter DJ, Lagiou P, Mucci L, eds. The portal vein is expanded and completely filled with tumor thrombus (black arrow). Salem R, Hunter RD. Only about 10% of HCCs develop in non-cirrhotic livers[7]. CT image quality is strongly proportional to radiation dose. 9:261. [Full Text]. The .gov means its official. Unenhanced (a) T1-weighted image showing a hypointense nodule (white arrow) in the left lobe and minimal enhancement in the arterial phase (b) and appears hypointense on the portal venous and delayed phases (not shown). Lancet. Kudo M, et al; TACTICS study group. 1) to the liver on unenhanced images but may appear hyperdense when they develop in a background of fatty liver. [QxMD MEDLINE Link]. WebThe gross pathology of hepatocellular carcinoma is a direct reflection of the imaging findings. Nat Genet. Early diagnosis of recurrent hepatocellular carcinoma with 18F-FDG PET after radiofrequency ablation therapy. Nomenclature of hepatic anatomy and resections: a review of the Brisbane 2000 system. King J, Palmer DH, Johnson P, Ross P, Hubner RA, Sumpter K, et al. TACE can also be performed safely for palliative tumor control in patients with advanced HCC with portal vein thrombosis[97]. Multifocal HCCs well demonstrated using super paramagnetic iron oxide particle imaging. [Full Text]. DWI and hepatocyte-specific MRI contrast agents are increasingly used in routine clinical practice and show great promise in improving imaging diagnosis and assessment of post-treatment outcome. [QxMD MEDLINE Link]. If you log out, you will be required to enter your username and password the next time you visit. Newer contrast agents that specifically target hepatic cells have been introduced to improve the diagnosis of HCC. Viral Hepatitis. [QxMD MEDLINE Link]. Fatty HCC. 2019 Feb. 20 (2):282-296. In: DeVita, Hellman, and Rosenberg's Cancer: Principles & Practice of Oncology. It uses sound waves to create an image on a computer screen. Ann Oncol. Stefaniuk P, Cianciara J, Wiercinska-Drapalo A. Recurrence of hepatocellular carcinoma after liver transplant: patterns and prognosis. Both contrast agents can be injected as an intravenous bolus that can provide information on vascularity and then information about hepatocyte function at 20min (Gd-EOB-DTPA) or >60min (Gd-BOPTA) after injection. World Health Organization. Medscape Medical News. the diagnosis of hepatocellular carcinoma Abstract Ultrasonography (US) is a major, sustainable hepatocellular carcinoma (HCC) surveillance method as it provides inexpensive, real-time, and noninvasive detection. [Full Text]. Management of hepatocellular carcinoma: an update. Hepatocellular carcinoma: the need for progress. [QxMD MEDLINE Link]. Nasu K, Kuroki Y, Tsukamoto T, Nakajima H, Mori K, Minami M. Diffusion-weighted imaging of surgically resected hepatocellular carcinoma: imaging characteristics and relationship among signal intensity, apparent diffusion coefficient, and histopathologic grade. Following rapid intravenous infusion of contrast, imaging is MRI provides an excellent method for characterizing HCC without radiation and the need for iodinated contrast. [QxMD MEDLINE Link]. July 27, 2021; Accessed: July 28, 2021. [Guideline] Gordan JD, Kennedy EB, Abou-Alfa GK, et al. [Guideline] NCCN Clinical Practice Guidelines in Oncology: Hepatobiliary Cancers. Portolani N, Coniglio A, Ghidoni S, Giovanelli M, Benetti A, Tiberio GA, et al. Hence, a modified RECIST (mRECIST) has been developed for evaluation of treatment response in HCC; only well-delineated arterially enhancing lesions can be selected as target lesions for mRECIST evaluation[98]. Regorafenib for patients with hepatocellular carcinoma who progressed on sorafenib treatment (RESORCE): a randomised, double-blind, placebo-controlled, phase 3 trial. Risk of HCC: genetic heterogeneity and complex genetics. Li M, Zhao H, Zhang X, Wood LD, Anders RA, Choti MA, et al. Sugimachi K, Maehara S, Tanaka S, et al. CT diagnosis of early hepatocellular carcinoma: sensitivity, findings MRI of HCC generally demonstrates high signal intensity on T2 imaging. The other typical imaging features include internal mosaic pattern (Fig. [QxMD MEDLINE Link]. Distinguishing hypervascular pseudolesions of the liver from hypervascular hepatocellular carcinomas with gadoxetic acid-enhanced MR imaging. Hepatocellular carcinoma: ESMO Clinical Practice Guidelines for diagnosis, treatment and follow-up. In addition, autoantibodies that have the ability to recognize the presence of abnormal tumor-associated antigens are promising biomarkers for the early detection of HCC[89]. Hepatocellular carcinoma in cirrhotic liver disease: functional computed tomography with perfusion imaging in the assessment of tumor vascularization. Kim HS, El-Serag HB. International Agency for Research on Cancer. Oral Psoriasis Drugs: What Are NPs Prescribing? Imaging of hepatocellular carcinoma and image guided therapies Instead, the PVTT itself can show arterial phase enhancement and subsequent washout (Fig. Courtesy of Memorial Sloan-Kettering Cancer Center, featuring Leslie H. Blumgart, MD. Hepatology. 277-308. Post TARE results in liquefaction necrosis (Fig. The https:// ensures that you are connecting to the [47]. Nguyen et al reported that arginase-1 and hepatocyte paraffin antigen 1 (Hep Par 1) had the highest sensitivity for well-differentiated HCC, whereas arginase-1 and glypican-3 had the highest sensitivity for poorly differentiated HCC. [QxMD MEDLINE Link]. J Hepatol. 1998 Jan-Feb. 2 (1):21-7. Choi D, Lim HK, Kim SH, et al. Ippolito D, Sironi S, Pozzi M, et al. Examples of post-RFA recurrence. Clin Cancer Res. Harrison, P. Liver Cancer Increase Driven Mainly by NASH in Men Over 60. The diagnosis is based on the qualitative or visual appreciation of differences in attenuation on CT, echogenicity on CEUS and signal intensities on MRI of the HCC with respect to surrounding liver parenchyma. Early diagnosis of HCC is important as several potentially curative treatment options are available that can then lead to an improved outcome. N Engl J Med. N Engl J Med. [QxMD MEDLINE Link]. Fewer than 10% of these patients survive longer than 3 years. 8)[47]. Gastroenterology. Arguedas MR, Chen VK, Eloubeidi MA, Fallon MB. Therefore, ongoing research into the detection and characterization of small lesions is especially important. Estimates of worldwide burden of cancer in 2008: GLOBOCAN 2008. 14), respectively, due to coagulation necrosis[99]. Hepatocellular carcinoma (HCC) ranks sixth in cancer incidence and third in cancer mortality worldwide[1]. Whereas some groups require biopsy before transplantation, Murakami T, Kim T, Hori M, Federle MP. LRT results in cellular necrosis, which then causes increased membranous permeability allowing free diffusion of water molecules and resulting in reduced DWI and a marked increase in the ADC value[56]. Accessed: February 28, 2022. In clinical practice, computed tomography (CT) is used as a second-line diagnostic imaging modality to confirm the presence of focal liver lesions suspected as hepatocellular carcinoma on prior diagnostic test such as abdominal ultrasound or alpha-foetoprotein, or both, either in surveillance programmes or in clinical settings. Yttrium-90 microspheres for the treatment of hepatocellular carcinoma: a review. Selection criteria for liver transplantation in early-stage hepatocellular carcinoma with cirrhosis: results of a multicenter study. The diagnosis of hepatocellular carcinoma (HCC) can oftenbe established on the basis of noninvasive imaging, without biopsy confirmation. ), Right hepatectomy. The lesion ranges from isointense to hyperintense (bright) on T1-weighted images. Nodular recurrence (white arrowheads) seen at 1 year at the margins of the ablation zone. [QxMD MEDLINE Link]. [39]. Laboratory Studies Serologically, hepatocellular adenomas (HCAs) (hepatic adenomas) are a diagnosis of exclusion. [QxMD MEDLINE Link]. Kelekis NL, Semelka RC, Worawattanakul S, et al. PET using [18F]fluorodeoxyglucose (FDG) can be useful in the detection of extrahepatic metastases that are not seen with CT or MRI, however, it has a low sensitivity for small and/or well-differentiated HCCs located within the liver secondary to the high background liver uptake of FDG[82], with FDG-PET missing 3050% of HCC lesions[83]. 84(2):495-511, x. Given recent advances in MRI-based fat quantification techniques, we investigated a possible relationship between The tumor thrombus demonstrates neovascularity of cast of vessels in the arterial phase (a) and washout in the portal venous phase (b). Approach to the adult patient with an incidental solid liver lesion Sahani DV, Holalkere NS, Mueller PR, Zhu AX. Gadoxetate dimeglumine (Gd-EOB-DTPA, Primovist in Europe and Eovist in the United States, Bayer HealthCare; and gadobenate dimeglumine (Gd-BOPTA, Multihance, Bracco, Milan, Italy) are 2 hepatocyte-specific contrast agents available for clinical studies. Space-occupying lesions of the liver. Dynamic and multiphase contrast-enhanced computed tomography (CT) and magnetic resonance imaging (MRI) are the standard diagnostic tests for HCC. Clin Chem Lab Med. Jang HJ, Kim TK, Burns PN, Wilson SR. Enhancement patterns of hepatocellular carcinoma at contrast-enhanced US: comparison with histologic differentiation. DeVita VT Jr, Lawrence TS, Rosenberg SA, eds. Please confirm that you would like to log out of Medscape. Chang MH, Chen CJ, Lai MS, Hsu HM, Wu TC, Kong MS, et al. The traditional pathologic TNM (tumor-node-metastasis) staging system, while helpful in determining a prognosis in patients undergoing resection, is not as useful in planning treatment, because it fails to include measures of the severity of the liver disease. Cancer Treat Rev. Int J Cancer. Tumour-agnostic efficacy and safety of selpercatinib in patients with RET fusion-positive solid tumours other than lung or thyroid tumours (LIBRETTO-001): a phase 1/2, open-label, basket trial. Kamel IR, Liapi E, Reyes DK, Zahurak M, Bluemke DA, Geschwind JF. Screening and Surveillance of Hepatocellular Carcinoma: An Introduction to Ultrasound Liver Imaging Reporting and Data System. Philadelphia PA: Wolters Kluwer; 2018. Patients with larger tumors (ie, single tumors < 5 cm or multiple [ 3] tumors < 3 cm) are considered for resection if they have preserved liver function or for transplantation if they have decompensated cirrhosis. Hepatocellular carcinoma: recent trends in the United States. Liver Transpl. The benefits of contrast-enhanced studies must be balanced against the risks if any anatomic or functional renal impairment is possible. 2008 Jul 24. Available at http://gco.iarc.fr/today/data/factsheets/cancers/11-Liver-fact-sheet.pdf. Kojiro M, Roskams T. Early hepatocellular carcinoma and dysplastic nodules. Role of diffusion-weighted imaging in estimating tumour necrosis after chemoembolization of hepatocellular carcinoma. PurposeThe aim of this study is to investigate the morphological characteristics and clinical significance of magnetic resonance (MR) images of peritumor margin enhancement in hepatocellular carcinoma (HCC) after drug-eluting bead transcatheter arterial chemoembolization (DEB-TACE).MethodsFrom January 2017 to CT and MR Imaging Diagnosis and Staging of 13) that may exhibit a thin, uniform peripheral rim of contrast enhancement in the arterial and/or portal venous phases, which may represent reactive hyperemia or granulation tissue[2]. Part 3: Suturing and dividing. Currently ultrasonography (US) is the recommended screening modality for periodic surveillance for HCC in at-risk patients. [41, 42], Table 2. HHS Vulnerability Disclosure, Help Hepatocellular carcinoma. Laghi A, Iannaccone R, Rossi P, et al. 1 Introduction. Treatment outcomes for hepatocellular carcinoma using chemoembolization in combination with other therapies. [36], USidentification of HCC can be difficult in the background of regenerative nodules in the cirrhotic liver. [QxMD MEDLINE Link]. Video Atlas: Liver, Biliary & Pancreatic Surgery. These patients can often undergo resection safely with excellent long-term survival. Meta-analysis: evaluation of adjuvant therapy after curative liver resection for hepatocellular carcinoma. There is no recurrence at 3 months and the large ablation zone covers the tumor region. Hepatocellular carcinoma in an ectopic Terrault N, Chen YC, Izumi N, Kayali Z, Mitrut P, Tak WY, et al. The incidence of HCC also increases with HIV infection[14]. Hepatocellular Carcinoma: Illustrated Guide to Systematic Kupffer cells are rarely present in HCCs, therefore, the tumor shows little or no uptake of SPIO and appears hyperintense to normal liver (Fig. Viable tumors are highly cellular and have intact cell membranes, thus restricting the motion of water molecules resulting in hyperintensity on DWI and reduction in the apparent diffusion coefficient (ADC)[56]. Liver cancer - Symptoms and causes - Mayo Clinic Surg Clin North Am. The introduction of MDCT has increased both the spatial and temporal resolution of CT making it possible to precisely evaluate the hemodynamics of liver tumors and liver parenchyma. Surg Clin North Am. 2020 May 14. [Guideline] Su GL, Altayar O, O'Shea R, Shah R, Estfan B, Wenzell C, et al. In-phase and opposed phase images can show microscopic fat components within HCCs (Fig. 105 (6):606-11. CT and MRI play an important role in confirming the fact that tumors are solitary and remain single with no macrovascular involvement. The typical features may be present in only 2662% of 12cm HCCs using CEUS, CT or MRI alone[23,27,28]. Tumor markers may be used in conjunction with US, however the sensitivity of serum alpha-fetoprotein (AFP) is low and results in additional detection of only 68% of cases with high false-positive results thereby increasing the cost of surveillance[1719]. Several imaging modalities including ultrasonography (US), computed tomography (CT), magnetic resonance imaging (MRI), positron emission tomography (PET) and angiography are used in evaluating patients with chronic liver disease and suspected HCC. Diffusion-weighted MRI provides additional value to conventional dynamic contrast-enhanced MRI for detection of hepatocellular carcinoma. AFP levels can also be elevated because of other conditions, such as following liver resection (transient until regeneration complete), recovery following toxic injury, or seroconversion following hepatitis B infection (typically inducing transient exacerbation of inflammation). The surgical treatment of primary hepatobiliary malignancy. Lencioni R, Crocetti L. A critical appraisal of the literature on local ablative therapies for hepatocellular carcinoma. 2013 Apr. 2006 Nov. 12(11 Suppl 2):S8-13. Hepatocellular carcinoma risk factors and disease burden in a European cohort: a nested case-control study. Guan YS, Sun L, Zhou XP, Li X, Zheng XH. Hepatocellular carcinoma (HCC) is one of the most common malignancies worldwide and one of the few malignancies with an increasing McKillop IH, Moran DM, Jin X, Koniaris LG. 10(5):761-80. Polesel J, Zucchetto A, Montella M, et al. A randomized phase II study of drug-eluting beads versus transarterial chemoembolization for unresectable hepatocellular carcinoma. Marelli L, Stigliano R, Triantos C, et al. [Guideline] Marrero JA, Ahn J, Rajender Reddy K, Americal College of Gastroenterology. Additional value of SPIO-enhanced MR imaging for the noninvasive imaging diagnosis of hepatocellular carcinoma in cirrhotic liver. Imaging is important for establishing a diagnosis of HCC. CEUS of HCC. Available at https://www.cancer.org/content/dam/cancer-org/research/cancer-facts-and-statistics/annual-cancer-facts-and-figures/2022/2022-cancer-facts-and-figures.pdf. The role of CEUS in the diagnosis of HCC is still controversial and is not recommended due to low specificity[25]. However, recent studies have shown conflicting results with regard to the usefulness of this technique for the characterization of HCC with high ARFI values occurring in benign as well as in malignant liver lesions[80,81]. Courtesy of Memorial Sloan-Kettering Cancer Center, featuring Leslie H. Blumgart, MD. Advanced MRI methods for assessment of chronic liver disease. Although MRS is finding its application in the quantification of liver fat content, its use in characterization and diagnosis of liver tumors is still in its infancy and research in this direction is ongoing. Follow-up imaging may show reduction in the size of the lesions. Abou-Alfa GK, Chan SL, Kudo M, Lau G, Kelley RK, Furuse J, et al. Diffusion-weighted MR imaging of the liver. WebHepatocellular carcinoma (HCC) is the sixth-most common cancer in the world, and hepatic dynamic CT studies are routinely performed for its evaluation. Semi-invasive techniques such as hepatic angiography, angiography-assisted CT hepatic angiography (Fig. Large HCCs with PVTT less often demonstrate the typical arterial phase hypervascularity and subsequent washout diagnostic of HCC. CT arteriography of HCC (arrow) in a 66-year-old patient with cryptogenic cirrhosis. hepatocellular Bruix J, Sherman M, Llovet JM, et al. aDiagnostic Imaging, National University Hospital, National University Health System, Singapore; bDepartment of Radiology, Mayo Clinic, Rochester, MN, USA. Hepatocellular carcinoma: Detection with diffusion-weighted vs. contrast-enhanced MRI in pre-transplant patients. However, for the best possible comparability of images, serial post-treatment follow-up is ideally performed with the same modality used to assess the presence of the tumor before and after LRT[74]. FDG-PET has also been shown to be of value in the detection of tumor recurrence after LRT[3]. J Clin Oncol. [QxMD MEDLINE Link]. Double arterial phase multi-detector row helical CT for detection of hypervascular hepatocellular carcinoma. The additional radiation dose needs to be considered when performing quadruple phase CT and studies have shown that late arterial phase CT is superior and adequate, with no significant benefit of an early arterial phase[33,34]. Gd-EOB-DTPA therefore has significant advantages in terms of safety, timing of examination and potentially better contrast. AGA Clinical Practice Guideline on Systemic Therapy for Hepatocellular Carcinoma. Consensus report of the 4th international forum for gadolinium-ethoxybenzyl-diethylenetriamine pentaacetic acid magnetic resonance imaging. When HCC invades a portal vein or its branches, it continues to receive blood supply from the hepatic artery and may drain directly into the portal vein. Bugianesi E. Non-alcoholic steatohepatitis and cancer. [QxMD MEDLINE Link]. Diagnosis, Staging, and Management of Hepatocellular Carcinoma: 2018 Practice Guidance by the American Association for the Study of Liver Diseases. DWI has a very high sensitivity for detection of nodules (Fig. 84 (2):413-35, viii. [QxMD MEDLINE Link]. [QxMD MEDLINE Link]. 2006. On unenhanced images, the appearance of HCC is variable and depends on the surrounding liver parenchyma and etiology of chronic liver disease. [QxMD MEDLINE Link]. In patients whose tumor exceeds these measurements, palliative therapy can be offered depending upon hepatic reserve. However, DWI may not be suitable for evaluating lesions near the dome of the liver secondary to magnetic susceptibility effects related to air in the lungs[60]. MRI proton density fat fraction for estimation of tumor grade in Barcelona Clinic Liver Cancer staging. MR elastography of liver tumours: preliminary results. Clin Transplant. Patient Survival Rates Following Liver Transplantation for Hepatocellular Carcinoma, Table 4. DWI is particularly useful in initial screening of the liver as nearly 7095% of HCCs can appear hyperintense[5759] (Figs. Skandalakis JE, Skandalakis LJ, Skandalakis PN, Mirilas P. Hepatic surgical anatomy. 12(5):351-5. Post-ablation MRI (eh) after 4 weeks showing a larger heterogeneous hypointensity on the T2-weighted image (e) and mixed hyperintensity on the T1-weighted image (f) representing the ablation zone (white arrows). Medical imaging patterns of non-invasive contrast-enhanced CT in HCC patients are essential for accurate estimates of the clinical-stage, prognosis clinical decision-making, and determination of follow-up in primary hospitals. Lencioni R, Goletti O, Armillotta N, Paolicchi A, Moretti M, Cioni D, et al. Surgery. A T2-weighted image following SPIO administration shows a large mass in the left lobe and multiple smaller lesions in the right lobe. Busuttil RW, Farmer DG. 2018 Mar 24. Peng SY, Chen WJ, Lai PL, Jeng YM, Sheu JC, Hsu HC. Preoperative prediction model for macrotrabecular-massive There is no enhancement in the arterial phase (g) but a thin rim of post-ablation inflammatory enhancement (black arrow) seen in the portal venous phase (h). [Full Text]. Lee SA, Lee CH, Jung WY, et al. Sorensen M, Frisch K, Bender D, Keiding S. The potential use of 2-[. AFP is elevated in 75% of cases. Hence, US is typically used as a surveillance tool for HCC detection in cirrhotic livers and CT or MRI for further evaluation if a nodule >1cm is detected. [Guideline] Fetzer DT, Rodgers SK, Harris AC, Kono Y, Wasnik AP, Kamaya A, et al. Hepatocellular Carcinoma: Illustrated Guide to Systematic Careers, Unable to load your collection due to an error. Intrahepatic cholangiocarcinoma (ICC) is a malignant tumor that arises from the intrahepatic bile ducts. Malignant tumors are stiffer than benign tumors and up to 100 times stiffer than normal soft tissue[77]. Dual-tracer PET/CT imaging in evaluation of metastatic hepatocellular carcinoma. MR elastography of HCC in a background of cryptogenic liver cirrhosis. N Engl J Med. 140(3):840-9; quiz e12. Triple-phase CT (including an arterial phase, a portal venous phase, and a late washout phase) has been found to be highly accurate in the diagnosis and characterization of HCCs but, like US, may miss smaller lesions. 359 (4):378-90. El-Serag HB, Tran T, Everhart JE. Adapted from Llovet JM, Fuster J, Bruix J, Barcelona-Clinic Liver Cancer Group. CT 2004 Apr. [QxMD MEDLINE Link]. Federal government websites often end in .gov or .mil. 2005 Apr. CDC.gov. Most often, HCCs appear hypodense or isodense (Fig.
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