Presentation
Progressive abdominal enlargement of patient known to have HCV
Patient Data
The liver is enlarged and cirrhotic. There are innumerable small size nodules, most of them enhance avidly in arterial phase with rapid washout in portovenous and delayed phases.
Case Discussion
Diagnosis: Hepatocellular carcinoma (histopathologically proved).
Hepatocellular carcinoma is the most common primary liver malignancy and liver cirrhosis is the main predisposing factor. Triphasic CT, alpha fetoprotein and biopsy were the essential methods for diagnosis.
Recently according to American Association of the Study of Liver Disease (AASLD) update in 2010:
the diagnosis of HCC can be made for a focal hepatic lesion 1 cm or more with arterial hypervascularity and venous or delayed washout in either 4 phase MSCT or dynamic contrast-enhanced MRI and this actually preclude the need for biopsy
Alpha-fetoprotein is neither sensitive nor specific
Diffusion-weighted MRI can be used as a screening tool for HCC, particularly in cirrhotic patients with renal insufficiency. DWI can also delineate the extent of infiltrative HCC, as in such a case
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