HEPATOCELLULAR-CARCINOMA - FINDINGS ON SPIRAL CT DURING ARTERIAL PORTOGRAPHY

Background: To determine characteristic imaging features of hepatocellular carcinoma (HCC) on spiral CT during arterial portography (SCTAP) and to correlate the presence or absence of spontaneous portosystemic shunts with the degree of hepatic parenchymal enhancement during SCTAP in patients with HCC. Methods: SCTAP scans of 20 patients with HCC were retrospectively analyzed for tumor features, degree of hepatic parenchymal enhancement, and presence or absence of spontaneous portosystemic shunts. Results: Nineteen tumors (95%) were hypoattenuating masses and one (5%) was isoattenuating compared with the liver on SCTAP. In seven patients (35%), the tumor was homogeneous in attenuation. Tumor margins were smooth and regular in 12 patients (60%). Vascular invasion and encapsulation were depicted in 10 patients (50%). A high degree of hepatic parenchymal enhancement was observed in 14 patients; one of them (7%) had spontaneous portosystemic shunts. Poor or moderate enhancement was observed in six patients; five of them (83%) had spontaneous portosystemic shunts (p < .001). Conclusion: The presence of a low attenuated homogeneous intrahepatic mass with associated vascular invasion on SCTAP scans should raise the possibility of HCC. The presence of spontaneous portosystemic shunts is associated with poor or moderate parenchymal enhancement.