Today, I review, link to, and embed “CT Scan Liver Normal Vs Hepatocellular Carcinoma (HCC) Images | Liver Cancer Imaging Diagnoses” from Dr. Sam’s Imaging Library.
All that follows is from the above resource.
Feb 3, 2024CT Scan Liver Normal Vs Hepatocellular Carcinoma (HCC) Images | Liver Cancer Imaging Diagnoses *Cases: Common Causes & Risk Factors – 0:00 HCC- Tumor Markers – 0:38 Hepatocellular Carcinoma – 2:19 Hepatocellular Carcinoma – Common Causes & Risk Factors:
- Chronic Hepatitis B and C Infections
- Cirrhosis
- Non-Alcoholic Fatty Liver Disease (NAFLD) and Non-Alcoholic Steatohepatitis (NASH)
HCC- Tumor Markers:
- Alpha-fetoprotein (AFP): This is the most commonly used tumor marker for HCC. Elevated levels of AFP are often seen in patients with HCC, although not all HCC patients will have high AFP levels. Also, elevated AFP can be seen in other conditions such as chronic hepatitis and cirrhosis.
- Liver Function Tests (LFTs): While not specific for HCC, abnormalities in liver function tests can indicate liver disease, which is a risk factor for HCC. Tests include alanine transaminase (ALT), aspartate transaminase (AST), alkaline phosphatase (ALP), bilirubin, and albumin levels.
- Des-γ-carboxy prothrombin (DCP) or Prothrombin Induced by Vitamin K Absence-II (PIVKA-II): This is a more specific marker for HCC, often used in conjunction with AFP.
- AFP-L3%: The lens culinaris agglutinin-reactive fraction of AFP (AFP-L3%) is a specific isoform of AFP that is increased in some HCC patients. Higher percentages of AFP-L3% are associated with a higher risk of HCC.
Hepatocellular Carcinoma: Arterial Phase: 20–35 seconds after contrast is injected Arterial Phase Hyperenhancement: In the arterial phase, HCC lesions often show hyperenhancement (become brighter) compared to the surrounding liver tissue. This is due to the tumor’s high vascularity. Portal Venous Phase: 70–80 seconds after contrast is injected Washout in Portal Venous and Delayed Phases: In the portal venous and delayed phases, the tumor typically shows washout, meaning it becomes less enhanced compared to the surrounding liver parenchyma. This contrast between the phases is a key diagnostic feature. Capsule Appearance: A pseudo-capsule, appearing as a rim of enhancement in the portal venous or delayed phase, is sometimes seen around HCC lesions. This is due to the fibrous tissue or compressed liver parenchyma surrounding the tumor. Nodule-in-nodule appearance: On contrast-enhanced CT scans, the inner and outer nodules may exhibit different enhancement patterns. Outer enhancing mass, and inner non enhancing nodule Peritumoral Corona Enhancement: Enhancement appears as a halo or corona-like structure encircling the tumor. Peritumoral Corona Enhancement is still prominent in portal venous phase Bland Thrombus: Appears as a filling defect within the vessel on a contrast-enhanced CT scan. It does not enhance because it consists of blood clot material (like fibrin and blood cells) without active blood supply. Bland thrombus can occur due to cirrhosis or HCC Tumor in Vein Sign: When the thrombus is caused by tumor invasion (tumor thrombus), it may enhance after contrast administration, which is known as the “tumor in vein” sign. This enhancement is because the thrombus contains neoplastic cells and thus has similar enhancement characteristics to the primary tumor. Mosaic Appearance: Heterogeneous Enhancement: Different areas within the tumor enhance variably after the administration of contrast. This is due to the presence of various histological components within the tumor, such as fibrosis, necrosis, hemorrhage, or fatty changes Diffuse HCC: Widespread infiltration of the liver parenchyma without forming a discrete mass. Involves both left and right lobes of the liver. Heterogeneous Enhancement: During the arterial phase of contrast-enhanced CT, there may be heterogeneous enhancement of the liver. This is due to the varying vascularity of the tumor tissue compared to the surrounding liver parenchyma. Patchy or Nodular Areas of Enhancement: In the arterial phase, there might be areas that show patchy or nodular enhancement, which become less conspicuous or wash out in the portal venous or delayed phases. Hepatomegaly: The liver may be enlarged due to the widespread presence of cancerous cells. This is a non-specific sign. Ascites: The presence of ascites can be a sign of advanced liver disease or portal hypertension, which may accompany diffuse HCC.
