Hepatocellular Carcinoma in Noncirrhotic Liver: CT, Clinical, and Pathologic Findings in 39 U.S. Residents

[Guest guest]

(Radiology 2002;222:89-94.)

© RSNA, 2001

Gastrointesinal Imaging

Hepatocellular Carcinoma in Noncirrhotic Liver: CT, Clinical, and Pathologic

Findings in 39 U.S. Residents1

Giuseppe Brancatelli, MD, P. Federle, MD, Luigi Grazioli, MD2 and

I. Carr, MD, PhD

1 From the Department of Radiology (G.B., M.P.F., L.G.) and Starzl

Transplantation Institute (B.I.C.), University of Pittsburgh Medical Center,

200 Lothrop St, Pittsburgh, PA 15213. Received April 10, 2001; revision

requested May 17; revision received July 11; accepted July 17. Address

correspondence to M.P.F. (e-mail: federle@...).

PURPOSE: To review clinical, pathologic, and computed tomographic (CT)

findings in patients with hepatocellular carcinoma (HCC) in noncirrhotic

liver.

MATERIALS AND METHODS: Clinical, pathologic, and imaging findings were

retrospectively evaluated in 39 patients with HCC in noncirrhotic liver.

Helical multiphasic CT scans obtained with 125 mL of contrast medium at a

rate of 4 or 5 mL/sec were reviewed for morphologic features such as tumor

size, margins, and hemorrhage and degree of enhancement.

RESULTS: All patients (25 men, 14 women; mean age, 61 years) were U.S.

residents; none had an Asian surname. Twenty-four patients (62%) had no

identifiable risk factors; 34 (87%) were symptomatic. HCC was proved and

cirrhosis excluded with biopsy in all cases. HCC was moderately (n = 32) or

well (n = 6) differentiated in 97% of cases and poorly differentiated in

one. Serum -fetoprotein level was elevated in 26 patients. Large tumors

(mean diameter, 12.4 cm) were depicted at CT in all cases. Thirty-two

patients had a solitary or dominant mass. At CT, tumor margins were well

defined in 21 patients, with a lobulated surface in 33. Calcifications were

depicted in 11, hemorrhage in 10, fat in four, dilated intrahepatic bile

ducts in 17, and abdominal lymphadenopathy in eight. In 38 patients, tumors

were heterogeneous with areas of necrosis. HCC was hypoattenuating on

nonenhanced images in 34, heterogeneously hyperattenuating at arterial phase

in 38, and hypoattenuating at portal phase in 35 patients.

CONCLUSION: HCC developed in the absence of cirrhosis or known risk factors

and typically appeared as a large symptomatic hepatic tumor with clinical,

laboratory, and CT features that distinguish it from most other hepatic

masses.

Index terms: Liver neoplasms, 761.323 . Liver neoplasms, CT, 761.12114,

761.12115 . Liver neoplasms, diagnosis, 761.12114, 761.12115

[Guest guest]

(Radiology 2002;222:89-94.)

© RSNA, 2001

Gastrointesinal Imaging

Hepatocellular Carcinoma in Noncirrhotic Liver: CT, Clinical, and Pathologic

Findings in 39 U.S. Residents1

Giuseppe Brancatelli, MD, P. Federle, MD, Luigi Grazioli, MD2 and

I. Carr, MD, PhD

1 From the Department of Radiology (G.B., M.P.F., L.G.) and Starzl

Transplantation Institute (B.I.C.), University of Pittsburgh Medical Center,

200 Lothrop St, Pittsburgh, PA 15213. Received April 10, 2001; revision

requested May 17; revision received July 11; accepted July 17. Address

correspondence to M.P.F. (e-mail: federle@...).

PURPOSE: To review clinical, pathologic, and computed tomographic (CT)

findings in patients with hepatocellular carcinoma (HCC) in noncirrhotic

liver.

MATERIALS AND METHODS: Clinical, pathologic, and imaging findings were

retrospectively evaluated in 39 patients with HCC in noncirrhotic liver.

Helical multiphasic CT scans obtained with 125 mL of contrast medium at a

rate of 4 or 5 mL/sec were reviewed for morphologic features such as tumor

size, margins, and hemorrhage and degree of enhancement.

RESULTS: All patients (25 men, 14 women; mean age, 61 years) were U.S.

residents; none had an Asian surname. Twenty-four patients (62%) had no

identifiable risk factors; 34 (87%) were symptomatic. HCC was proved and

cirrhosis excluded with biopsy in all cases. HCC was moderately (n = 32) or

well (n = 6) differentiated in 97% of cases and poorly differentiated in

one. Serum -fetoprotein level was elevated in 26 patients. Large tumors

(mean diameter, 12.4 cm) were depicted at CT in all cases. Thirty-two

patients had a solitary or dominant mass. At CT, tumor margins were well

defined in 21 patients, with a lobulated surface in 33. Calcifications were

depicted in 11, hemorrhage in 10, fat in four, dilated intrahepatic bile

ducts in 17, and abdominal lymphadenopathy in eight. In 38 patients, tumors

were heterogeneous with areas of necrosis. HCC was hypoattenuating on

nonenhanced images in 34, heterogeneously hyperattenuating at arterial phase

in 38, and hypoattenuating at portal phase in 35 patients.

CONCLUSION: HCC developed in the absence of cirrhosis or known risk factors

and typically appeared as a large symptomatic hepatic tumor with clinical,

laboratory, and CT features that distinguish it from most other hepatic

masses.

Index terms: Liver neoplasms, 761.323 . Liver neoplasms, CT, 761.12114,

761.12115 . Liver neoplasms, diagnosis, 761.12114, 761.12115