Figure 1
Native CT scan
Native CT scan shows a slightly lobulated liver contour with ascites and dilated bile ducts and an enlarged spleen.
Clinical History
History of cirrhosis and obstructive jaundice. Ultrasonography showed dilated bile ducts and an inhomogeneous liver parenchyma. An ampulloma was diagnosed endoscopically and an intracanalicular stent was introduced. In the follow-up, laboratory results showed a raising alphafetoprotein level.
Imaging Findings
Patient admitted with a history of cirrhosis and obstructive jaundice. Ultrasonography showed dilated bile ducts and an inhomogeneous liver parenchyma. An ampulloma was diagnosed endoscopically and an intracanalicular stent was introduced.
Cholestasis progressively subsided but laboratory results showed a raising alphafetoprotein level. CT scan and MRI were requested to rule out a hepatoma.
Discussion
Hepatocellular carcinoma (HCC) is a primary malignant neoplasm of the liver most common in Africa and Asia frequently associated with cirrhosis.
Patients present with aspecific symptoms. An abdominal mass is sometimes palpable in later stages. Laboratory results often show a markedly elevated alphafetoprotein level. More than 75% of patients with HCC have extrahepatic spread at the time of diagnosis. CT shows a solitary mass or possibly satellite lesions.
MRI is superior to CT in demonstrating the fibrous capsule seen in 50% of the hepatomas and in delineating the tumor margin and venous invasion. Intravenous administration of super-paramagnetic iron oxide (SPIO) considerably enhances contrast between hepatoma and normal liver tissue due to T2 shortening. SPIO particles are phagocytised by cells of the macrophage-monocytic system which results in a marked signal loss of normal liver tissue.
Most malignant tumors lack reticuloendothelial cells and do not loose signal after SPIO infusion and thus show a higher signal compared to the normal liver tissue. The iron oxide contrast not only improves diagnostic confidence but also allows better delineation of the tumor margins compared to the precontrast images.
Differential Diagnosis List
Hepatocellular carcinoma
Final Diagnosis
Hepatocellular carcinoma
References
[1] Denys A, Arrive L, Servois V et al. Hepatic Tumors: detection and characterisation at 1.0 T MR enhanced with AMI-25. Radiology 1994; 193: 665-669. (PMID: 7972805)
[2] Grandin C, Van Beers BE, Robert A. et al. Benign hepatocellular tumors: MRI after Superparamagnetic Iron Oxide Administration. J Comput Assist Tomogr 1995; 19: 412-418. (PMID: 7790551)
[3] Grangier C, Tourniaire J, Mentha G. et al. Enhancement of liver hemangiomas on T1-weighted MR SE images by Superparamagnetic Iron Oxide Particles. J Comput Assist Tomogr 1994;18: 888-896. (PMID: 7962795)
Case information
| URL: | https://eurorad.org/case/906 |
| DOI: | 10.1594/EURORAD/CASE.906 |
| ISSN: | 1563-4086 |
Figure 2
Contrast enhanced CT scan
Contrast enhanced CT scan demonstrates a slightly inhomogeneous liver parenchyma but no definite mass lesion.
Figure 3
Magnetic Resonance Imaging
Axial SE T1-weighted image demonstrates a light bulging of the left liver contour with suspicion of irregularly outlined mass in the left liver lobe.
Axial SE T2-weighted image shows an ill-defined, slightly hyperintense lesion in the quadrate lobe. No evidence for infiltration of the hilum or parahilar region of the right liver lobe.
Axial SE proton density weighted images with 10 mm slice interval, one hour after administration of superparamagnetic iron oxide (AMI-25, 15 umol/kg) demonstrates a mass in the quadrate lobe with infiltration of the liver hilum and the parahilar region of the right liver lobe. Intermediate signal intensity of the tumor, compared to the very low signal intensity of adjacent liver parenchyma is seen. Nodular appearance of the cirrhotic liver parenchyma is noted.
Same as 3c, more caudal slice
Native CT scan
Native CT scan shows a slightly lobulated liver contour with ascites and dilated bile ducts and an enlarged spleen.
Contrast enhanced CT scan
Contrast enhanced CT scan demonstrates a slightly inhomogeneous liver parenchyma but no definite mass lesion.
Magnetic Resonance Imaging
Axial SE T1-weighted image demonstrates a light bulging of the left liver contour with suspicion of irregularly outlined mass in the left liver lobe.
Axial SE T2-weighted image shows an ill-defined, slightly hyperintense lesion in the quadrate lobe. No evidence for infiltration of the hilum or parahilar region of the right liver lobe.
Axial SE proton density weighted images with 10 mm slice interval, one hour after administration of superparamagnetic iron oxide (AMI-25, 15 umol/kg) demonstrates a mass in the quadrate lobe with infiltration of the liver hilum and the parahilar region of the right liver lobe. Intermediate signal intensity of the tumor, compared to the very low signal intensity of adjacent liver parenchyma is seen. Nodular appearance of the cirrhotic liver parenchyma is noted.
Same as 3c, more caudal slice