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Li X, Zhang X, Li Z, Xie C, Qin S, Yan M, Ke Q, Jin X, Lin T, Zhou M, Liang W, Qi Z, Geng Z, Quan X. Two-Trait Predictor of Venous Invasion on Contrast-Enhanced CT as a Preoperative Predictor of Outcomes for Early-Stage Hepatocellular Carcinoma After Hepatectomy. Front Oncol 2021; 11:688087. [PMID: 34540664 PMCID: PMC8442625 DOI: 10.3389/fonc.2021.688087] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2021] [Accepted: 08/10/2021] [Indexed: 12/24/2022] Open
Abstract
Objectives This study aimed to assess the effectiveness of the two-trait predictor of venous invasion (TTPVI) on contrast-enhanced computed tomography (CECT) for the preoperative prediction of clinical outcomes in patients with early-stage hepatocellular carcinoma (HCC) after hepatectomy. Methods This retrospective study included 280 patients with surgically resected HCC who underwent preoperative CECT between 2012 and 2013. CT imaging features of HCC were assessed, and univariate and multivariate Cox regression analyses were used to evaluate the CT features associated with disease-free survival (DFS) and overall survival (OS). Subgroup analyses were used to summarized the hazard ratios (HRs) between patients in whom TTPVI was present and those in whom TTPVI was absent using a forest plot. Results Capsule appearance [HR, 0.504; 95% confidence interval (CI), 0.341–0.745; p < 0.001], TTPVI (HR, 1.842; 95% CI, 1.319–2.572; p < 0.001) and high level of alanine aminotransferase (HR, 1.620; 95% CI, 1.180–2.225, p = 0.003) were independent risk factors for DFS, and TTPVI (HR, 2.509; 95% CI, 1.518–4.147; p < 0.001), high level of alpha-fetoprotein (HR, 1.722; 95% CI, 1.067–2.788; p = 0.026), and gamma-glutamyl transpeptidase (HR, 1.787; 95% CI, 1.134–2.814; p = 0.026) were independent risk factors for OS. A forest plot revealed that the TTPVI present group had lower DFS and OS rates in most subgroups. Patients in whom TTPVI was present in stages I and II had a lower DFS and OS than those in whom TTPVI was absent. Moreover, there were significant differences in DFS (p < 0.001) and OS (p < 0.001) between patients classified as Barcelona Clinic Liver Cancer stage A in whom TTPVI was absent and in whom TTPVI was present. Conclusions TTPVI may be used as a preoperative biomarker for predicting postoperative outcomes for patients with early-stage HCC.
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Affiliation(s)
- Xinming Li
- Department of Radiology, Zhujiang Hospital, Southern Medical University, Guangzhou, China
| | - Xuchang Zhang
- Department of Radiology, Zhujiang Hospital, Southern Medical University, Guangzhou, China
| | - Zhipeng Li
- Department of Radiology, Sun Yat-sen University Cancer Center, Guangzhou, China
| | - Chuanmiao Xie
- Department of Radiology, Sun Yat-sen University Cancer Center, Guangzhou, China
| | - Shuping Qin
- Department of Radiology, Zhujiang Hospital, Southern Medical University, Guangzhou, China
| | - Meng Yan
- Department of Radiology, Zhujiang Hospital, Southern Medical University, Guangzhou, China
| | - Qiying Ke
- Department of Radiology, Zhujiang Hospital, Southern Medical University, Guangzhou, China
| | - Xuan Jin
- Department of Radiology, Zhujiang Hospital, Southern Medical University, Guangzhou, China
| | - Ting Lin
- Department of Radiology, Zhujiang Hospital, Southern Medical University, Guangzhou, China
| | - Muyao Zhou
- Department of Radiology, Zhujiang Hospital, Southern Medical University, Guangzhou, China
| | - Wen Liang
- Department of Radiology, Zhujiang Hospital, Southern Medical University, Guangzhou, China
| | - Zhendong Qi
- Department of Radiology, Zhujiang Hospital, Southern Medical University, Guangzhou, China
| | - Zhijun Geng
- Department of Radiology, Sun Yat-sen University Cancer Center, Guangzhou, China
| | - Xianyue Quan
- Department of Radiology, Zhujiang Hospital, Southern Medical University, Guangzhou, China
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Vouche M, Lewandowski RJ, Atassi R, Memon K, Gates VL, Ryu RK, Gaba RC, Mulcahy MF, Baker T, Sato K, Hickey R, Ganger D, Riaz A, Fryer J, Caicedo JC, Abecassis M, Kulik L, Salem R. Radiation lobectomy: time-dependent analysis of future liver remnant volume in unresectable liver cancer as a bridge to resection. J Hepatol 2013; 59:1029-36. [PMID: 23811303 PMCID: PMC5085290 DOI: 10.1016/j.jhep.2013.06.015] [Citation(s) in RCA: 198] [Impact Index Per Article: 18.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/28/2013] [Revised: 05/21/2013] [Accepted: 06/17/2013] [Indexed: 12/04/2022]
Abstract
BACKGROUND & AIMS Portal vein embolization (PVE) is a standard technique for patients not amenable to liver resection due to small future liver remnant ratio (FLR). Radiation lobectomy (RL) with (90)Y-loaded microspheres (Y90) is hypothesized to induce comparable volumetric changes in liver lobes, while potentially controlling the liver tumor and limiting tumor progression in the untreated lobe. We aimed at testing this concept by performing a comprehensive time-dependent analysis of liver volumes following radioembolization. METHODS 83 patients with right unilobar disease with hepatocellular carcinoma (HCC; N=67), cholangiocarcinoma (CC; N=8) or colorectal cancer (CRC; N=8) were treated by Y90 RL. The total liver volume, lobar (parenchymal) and tumor volumes, FLR and percentage of FLR hypertrophy from baseline (%FLR hypertrophy) were assessed on pre- and post-Y90 CT/MRI scans in a dynamic fashion. RESULTS Right lobe atrophy (p=0.003), left lobe hypertrophy (p<0.001), and FLR hypertrophy (p<0.001) were observed 1 month after Y90 and this was consistent at all follow-up time points. Median %FLR hypertrophy reached 45% (5-186) after 9 months (p<0.001). The median maximal %FLR hypertrophy was 26% (-14 → 86). Portal vein thrombosis was correlated to %FLR hypertrophy (p=0.02). Median Child-Pugh score worsening (6 → 7) was seen at 1 to 3 months (p=0.03) and 3 to 6 months (p=0.05) after treatment. Five patients underwent successful right lobectomy (HCC N=3, CRC N=1, CC N=1) and 6 HCCs were transplanted. CONCLUSIONS Radiation lobectomy by Y90 is a safe and effective technique to hypertrophy the FLR. Volumetric changes are comparable (albeit slightly slower) to PVE while the right lobe tumor is treated synchronously. This novel technique is of particular interest in the bridge-to-resection setting.
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Affiliation(s)
- Michael Vouche
- Department of Radiology, Section of Interventional Radiology and Division of Interventional Oncology, Northwestern University, Chicago, IL, USA
| | - Robert J. Lewandowski
- Department of Radiology, Section of Interventional Radiology and Division of Interventional Oncology, Northwestern University, Chicago, IL, USA
| | - Rohi Atassi
- Department of Radiology, Section of Interventional Radiology and Division of Interventional Oncology, Northwestern University, Chicago, IL, USA
| | - Khairuddin Memon
- Department of Radiology, Section of Interventional Radiology and Division of Interventional Oncology, Northwestern University, Chicago, IL, USA
| | - Vanessa L. Gates
- Department of Radiology, Section of Interventional Radiology and Division of Interventional Oncology, Northwestern University, Chicago, IL, USA
| | - Robert K. Ryu
- Department of Radiology, Section of Interventional Radiology and Division of Interventional Oncology, Northwestern University, Chicago, IL, USA
| | - Ron C. Gaba
- Department of Radiology, University of Illinois, Chicago, IL, USA
| | - Mary F. Mulcahy
- Department of Medicine, Division of Hematology and Oncology, Robert H. Lurie Comprehensive Cancer Center, Northwestern University, Chicago, IL, USA
| | - Talia Baker
- Department of Surgery, Division of Transplantation, Comprehensive Transplant Center, Northwestern University, Chicago, IL, USA
| | - Kent Sato
- Department of Radiology, Section of Interventional Radiology and Division of Interventional Oncology, Northwestern University, Chicago, IL, USA
| | - Ryan Hickey
- Department of Radiology, Section of Interventional Radiology and Division of Interventional Oncology, Northwestern University, Chicago, IL, USA
| | - Daniel Ganger
- Department of Medicine, Division of Hepatology, Northwestern University, Chicago, IL, USA
| | - Ahsun Riaz
- Department of Radiology, Section of Interventional Radiology and Division of Interventional Oncology, Northwestern University, Chicago, IL, USA
| | - Jonathan Fryer
- Department of Surgery, Division of Transplantation, Comprehensive Transplant Center, Northwestern University, Chicago, IL, USA
| | - Juan Carlos Caicedo
- Department of Surgery, Division of Transplantation, Comprehensive Transplant Center, Northwestern University, Chicago, IL, USA
| | - Michael Abecassis
- Department of Surgery, Division of Transplantation, Comprehensive Transplant Center, Northwestern University, Chicago, IL, USA
| | - Laura Kulik
- Department of Medicine, Division of Hepatology, Northwestern University, Chicago, IL, USA
| | - Riad Salem
- Department of Radiology, Section of Interventional Radiology and Division of Interventional Oncology, Northwestern University, Chicago, IL, USA,Department of Medicine, Division of Hematology and Oncology, Robert H. Lurie Comprehensive Cancer Center, Northwestern University, Chicago, IL, USA,Department of Surgery, Division of Transplantation, Comprehensive Transplant Center, Northwestern University, Chicago, IL, USA,Corresponding author. Address: Northwestern University, 676 N. St. Clair, Suite 800, Chicago, IL 60611, USA. (R. Salem)
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Early diffuse recurrence of hepatocellular carcinoma after percutaneous radiofrequency ablation: analysis of risk factors. Eur Radiol 2012; 23:190-7. [PMID: 23085860 DOI: 10.1007/s00330-012-2561-8] [Citation(s) in RCA: 49] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2012] [Revised: 05/21/2012] [Accepted: 06/04/2012] [Indexed: 12/22/2022]
Abstract
OBJECTIVE To evaluate the risk factors affecting early diffuse recurrence within 1 year of percutaneous ultrasound-guided radiofrequency ablation (RFA) for hepatocellular carcinoma (HCC). METHODS Out of 146 patients who received transcatheter arterial chemoembolisation (TACE) for treatment of recurrent HCC after percutaneous ultrasound-guided RFA, we selected 23 patients with early diffuse recurrence. Early diffuse recurrence was defined as three or more new recurrent HCCs within 1 year of initial RFA. As a control group, we selected 23 patients, matched exactly for age and sex, in which there was no local tumour progression or new recurrence after RFA. To analyse the risk factors, we examined patient factors and tumour factors. RESULTS Recurrent tumours occurred from 30 to 365 days after RFA (median time, 203 days). Univariate analysis indicated that larger tumour size and poorly defined margin were significant risk factors (P < 0.05). Multivariate analysis indicated that poorly defined margin was a significant risk factor (P < 0.05). CONCLUSION Larger tumour size and poorly defined margin may be risk factors for early diffuse recurrence of HCC within 1 year of RFA. Tumours with such risk factors should be treated with a combination of TACE to minimise the potential for therapeutic failure.
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Muhi A, Ichikawa T, Motosugi U, Sano K, Fatima Z, Matsuda M, Fujii H, Enomoto N, Araki T. Diffusion-weighted imaging of hepatocellular carcinoma for predicting early recurrence and survival after hepatectomy. Hepatol Int 2012. [PMID: 26201799 DOI: 10.1007/s12072-012-9383-2] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
PURPOSE The effectiveness of imaging (including apparent diffusion coefficient [ADC] of diffusion-weighted magnetic resonance imaging [DWI]) and laboratory variables for predicting early tumor recurrence and overall survival after surgery in hepatocellular carcinoma (HCC) patients are analyzed. METHODS The present study included 116 consecutive patients with HCC who underwent partial hepatectomy. Patients were classified into two groups: patients with and without early recurrence (<1 year). Preoperative imaging variables (tumor number, size, shape, capsule, ADC, and venous invasion) and laboratory variables were evaluated to predict early recurrence using univariate and multivariate analyses. Overall survival was calculated using the Kaplan-Meier method. RESULTS Twenty patients (17 %) developed early recurrence after surgery. Multivariate logistic regression analysis showed that tumor ADC (p = 0.0002), aspartate aminotransferase (p = 0.0121), and serum prothrombin time activity percentage (p = 0.0082) were statistically significant for predicting early recurrence. The optimal ADC cutoff value for predicting early recurrence obtained from receiver operating characteristic analysis was ≤0.898 × 10(-3) mm(2)/s. In patients with ADC ≤0.898 × 10(-3) mm(2)/s, the 3- and 5-year survival rates (77 and 56 %, respectively) were significantly decreased compared with those in patients with ADC >0.898 × 10(-3) mm(2)/s (97 and 97 %, respectively; p = 0.0015). CONCLUSIONS Low tumor ADC value by DWI was a risk factor for early postoperative HCC recurrence and was associated with lower patient survival rates.
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Affiliation(s)
- Ali Muhi
- Department of Radiology, University of Yamanashi, 1110 Shimokato, Chuo-shi, Yamanashi, 409-3898, Japan
| | - Tomoaki Ichikawa
- Department of Radiology, University of Yamanashi, 1110 Shimokato, Chuo-shi, Yamanashi, 409-3898, Japan.
| | - Utaroh Motosugi
- Department of Radiology, University of Yamanashi, 1110 Shimokato, Chuo-shi, Yamanashi, 409-3898, Japan
| | - Katsuhiro Sano
- Department of Radiology, University of Yamanashi, 1110 Shimokato, Chuo-shi, Yamanashi, 409-3898, Japan
| | - Zareen Fatima
- Department of Radiology, University of Yamanashi, 1110 Shimokato, Chuo-shi, Yamanashi, 409-3898, Japan
| | - Masanori Matsuda
- First Department of Surgery, University of Yamanashi, Yamanashi, Japan
| | - Hideki Fujii
- First Department of Surgery, University of Yamanashi, Yamanashi, Japan
| | - Nobuyuki Enomoto
- First Department of Internal Medicine, University of Yamanashi, Yamanashi, Japan
| | - Tsutomu Araki
- Department of Radiology, University of Yamanashi, 1110 Shimokato, Chuo-shi, Yamanashi, 409-3898, Japan
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Kim H, Park MS, Park YN, Kim H, Kim KS, Choi JS, Ahn SH, Han KH, Kim MJ, Kim KW. Preoperative radiologic and postoperative pathologic risk factors for early intra-hepatic recurrence in hepatocellular carcinoma patients who underwent curative resection. Yonsei Med J 2009; 50:789-95. [PMID: 20046419 PMCID: PMC2796405 DOI: 10.3349/ymj.2009.50.6.789] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/11/2008] [Revised: 01/11/2009] [Accepted: 01/11/2009] [Indexed: 12/23/2022] Open
Abstract
PURPOSE The risk of hepatocellular carcinoma (HCC) recurrence must be considered ahead of surgery. This study was undertaken to identify pre-operative risk factors for early intrahepatic recurrence of HCC after curative resection in a large-scale. MATERIALS AND METHODS We retrospectively reviewed the preoperative three-phase multi-detector CT (MDCT) and laboratory data for 240 HCC patients who underwent curative resection; tumor size, number, gross shape, capsule integrity, distinctiveness of tumor margin, portal vein thrombosis (PVT), alpha-fetoprotein level (AFP), and protein induced by vitamin K absence-II (PIVKA-II) levels were assessed. Surgical pathology was reviewed; tumor differentiation, capsule, necrosis, and micro-vessel invasion were recorded. RESULTS HCC recurred in 61 patients within six months (early recurrence group), but not in 179 patients (control group). In univariate analysis, large tumor size (p = 0.018), shape (p = 0.028), poor capsule integrity (p = 0.046), elevated AFP (p = 0.015), and PIVKA-II (p = 0.008) were significant preoperative risk factors. Among the pathologic features, PVT (p = 0.023), Glisson's capsule penetration (p = 0.033), microvascular invasion (p < 0.001), and poor differentiation (p = 0.001) showed statistical significance. In multivariate analysis, only the histopathologic parameters of microvascular invasion and poor differentiation achieved statistical significance. CONCLUSION Preoperative CT and laboratory parameters showed limited value, while the presence of microscopic vascular tumor invasion and poorly differentiated HCC correlated with higher risk of early recurrence after curative resection.
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Affiliation(s)
- Honsoul Kim
- Department of Diagnostic Radiology, Institute of Gastroenterology, Research Institute of Radiological Science, Yonsei University College of Medicine, Seoul, Korea
| | - Mi-Suk Park
- Department of Diagnostic Radiology, Institute of Gastroenterology, Research Institute of Radiological Science, Yonsei University College of Medicine, Seoul, Korea
| | - Young Nyun Park
- Department of Pathology, Yonsei University College of Medicine, Seoul, Korea
| | - Hyunki Kim
- Department of Pathology, Yonsei University College of Medicine, Seoul, Korea
| | - Kyung Sik Kim
- Department of Surgery, Yonsei University College of Medicine, Seoul, Korea
| | - Jin Sub Choi
- Department of Surgery, Yonsei University College of Medicine, Seoul, Korea
| | - Sang Hoon Ahn
- Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Korea
| | - Kwang-Hyub Han
- Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Korea
| | - Myeong-Jin Kim
- Department of Diagnostic Radiology, Institute of Gastroenterology, Research Institute of Radiological Science, Yonsei University College of Medicine, Seoul, Korea
| | - Ki Whang Kim
- Department of Diagnostic Radiology, Institute of Gastroenterology, Research Institute of Radiological Science, Yonsei University College of Medicine, Seoul, Korea
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Scirrhous hepatocellular carcinoma: comparison with usual hepatocellular carcinoma based on CT-pathologic features and long-term results after curative resection. Eur J Radiol 2007; 69:123-30. [PMID: 17976942 DOI: 10.1016/j.ejrad.2007.09.008] [Citation(s) in RCA: 61] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2007] [Revised: 09/11/2007] [Accepted: 09/11/2007] [Indexed: 02/08/2023]
Abstract
OBJECTIVE To compare the CT and pathologic features and the long-term results of scirrhous hepatocellular carcinoma (HCC) after a curative resection with those of usual HCC. METHODS Twenty-one patients with a scirrhous HCC and 296 patients with a usual HCC underwent contrast-enhanced triple-phase helical CT examinations before and after the curative resection. The CT and pathological features of scirrhous HCC, along with the cumulative survival and recurrence rates after the curative resection using a Kaplan-Meier method were compared with those of a usual HCC. RESULTS The common CT features of scirrhous HCC were an ill-defined tumor margin (76%), peripheral rim-like enhancement on arterial and portal phases (62%), presence of area of prolonged and delayed enhancement on equilibrium phase (95%), and hepatic surface retraction (59%) and the uncommon CT features were presence of washout area (19%) and tumor capsule enhancement (5%), which were significantly different from those of usual HCC (p<0.05). Pathologically, the tumor capsule formation (29%) and tumor necrosis or hemorrhage (10%) were significantly less than those (81% and 43%, respectively) in usual HCC (p<0.05), while portal or hepatic vein involvement (33%) was significantly more common than in usual HCC (9%) (p<0.05). There were no statistically significant differences in the 5-year cumulative survival and recurrence rates between the two groups (p>0.05). CONCLUSION Scirrhous HCC showed distinct CT and pathologic features from those of usual HCC. After the curative resection, the long-term results of scirrhous and usual HCCs were not significantly different.
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Lim JH, Choi D, Park CK, Lee WJ, Lim HK. Encapsulated hepatocellular carcinoma: CT-pathologic correlations. Eur Radiol 2006; 16:2326-33. [PMID: 16547706 DOI: 10.1007/s00330-006-0203-8] [Citation(s) in RCA: 57] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2005] [Revised: 12/05/2005] [Accepted: 02/07/2006] [Indexed: 12/12/2022]
Abstract
This study is a retrospective evaluation of the correlations between the presence and integrity of the capsule of nodular hepatocellular carcinomas (HCC) by dynamic CT and histopathology, with histopathologic evidence of tumor propagation to surrounding hepatic parenchyma. Dynamic CT scans of 75 nodular HCCs in 73 patients (61 men, 12 women; age range, 32-81; mean, 53) were evaluated regarding capsule visualization and integrity. Histopathologic findings of HCCs in resected specimens were correlated with the presence of a capsule, tumor invasion onto the capsule, and with the presence of microvascular emboli in the surrounding liver parenchyma. On histopathologic examination, capsules were present in 57 of 75 nodular HCCs; the capsules were invaded by tumor in 18 nodules and there were microvascular emboli around the nodular HCC in 49 cases. Capsule visualization by CT was correlated with the presence of capsule by histopathology (P<0.001). Disruption of capsule by CT was correlated with tumor invasion by histopathology (P=0.003) and with microvascular tumor emboli (P<0.001). The presence and structural integrity of HCC capsules on CT was closely correlated with the presence of capsule on histopathology and the absence of microvascular tumor emboli.
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Affiliation(s)
- Jae Hoon Lim
- Department of Radiology and Center for Imaging Science, Samsung Medical Center, Sungkyunkwan University School of Medicine, 50 Ilwon-dong, Kangnam-ku, 135-710, Seoul, South Korea.
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Tajima T, Yoshimitsu K, Irie H, Aibe H, Shinozaki K, Nishie A, Honda H, Shimada M. Detecting Postsurgical Recurrent Hepatocellular Carcinoma With Multiphasic Helical Computed Tomography. J Comput Assist Tomogr 2005; 29:42-50. [PMID: 15665682 DOI: 10.1097/01.rct.0000146482.64324.6e] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
OBJECTIVE The aim of this study was to assess the computed tomography (CT) patterns of postoperative recurrent hepatocellular carcinoma (HCC). METHODS Of 84 patients with histologically proven HCC by hepatectomies, multiphasic helical CT demonstrated 54 HCC lesions of intrahepatic recurrence in 31 (37%) patients. The initial and final appearances of HCC on hepatic arterial phase images were retrospectively determined by the serial CT scans, which were compared with appearances of primary HCC. RESULTS The initial appearances of 54 recurrent HCCs were identical to the appearances of primary HCC in 41 (76%) lesions. Serial changes from the initial appearance to the final appearance of recurrent HCC were observed in 10 (42%) of 24 lesions. The 13 discordant lesions and the 10 lesions with altered lesion vascularity in our series implied that at least 43% were of multicentric occurrence. CONCLUSION More than 40% of postoperative recurrent HCCs show intranodular hemodynamic changes. The incompatibility between CT findings of primary and recurrent HCCs implies that these tumors contain nodules of multicentric occurrence.
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Affiliation(s)
- Tsuyoshi Tajima
- Department of Clinical Radiology, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan.
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Lim JH, Park CK. Hepatocellular carcinoma in advanced liver cirrhosis: CT detection in transplant patients. ACTA ACUST UNITED AC 2004; 29:203-7. [PMID: 15290946 DOI: 10.1007/s00261-003-0114-y] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
Computed tomography (CT) is being used as the standard pretransplantation imaging for recipients and donors in the evaluation of liver volume, liver reserve function, vascular anatomy, diagnosis of hepatocellular carcinoma and metastasis, and global information of the abdominal cavity. Whereas CT detection of hepatocellular carcinoma in non-cirrhotic patients is satisfactory, detection sensitivity in severely cirrhotic patients is limited, with a reported sensitivity of 53% to 68%. Tumors smaller than 2 cm are more difficult to detect. Innumerable regenerative nodules, localized or diffuse fibrosis, arterioportal shunts, nodular surface, and distorted anatomy in end-stage liver cirrhosis make it difficult to detect small hepatocellular carcinoma. Because of the shortage of cadavers and living donors, judicious use of CT is necessary in the selection of candidates and the decision of priority for liver transplantation in patients with advanced liver cirrhosis.
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Affiliation(s)
- J H Lim
- Department of Radiology and the Center for Imaging Science, Samsung Medical Center, Sungkyunkwan University School of Medicine, 50 Ilwon-dong, Kangnam-ku, Seoul 135-710, Korea.
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