Diffuse hepatocellular carcinoma
Progressive abdominal enlargement of patient known to have HCV
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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.
Diagnosis: Hepatocellular carcinoma (histopatholgoically 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 the 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 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.
- 1- Rosenkrantz AB, Lee L, Matza BW et-al. Infiltrative hepatocellular carcinoma: comparison of MRI sequences for lesion conspicuity. Clin Radiol. 2012;67 (12): e105-11. doi:10.1016/j.crad.2012.08.019 - Pubmed citation
- 2- Manini MA, Sangiovanni A, Fornari F et-al. Clinical and economical impact of 2010 AASLD guidelines for the diagnosis of hepatocellular carcinoma. J. Hepatol. 2014;60 (5): 995-1001. doi:10.1016/j.jhep.2014.01.006 - Pubmed citation
- 3- Lim KS. Diffusion-weighted MRI of hepatocellular carcinoma in cirrhosis. Clin Radiol. 2014;69 (1): 1-10. doi:10.1016/j.crad.2013.07.022 - Pubmed citation