Rupture of hepatocellular carcinoma: predictive value of CT findings

To assess the value of CT in predicting spontaneous rupture of hepatocellular carcinoma, we reviewed CT scans obtained within 3 months before the rupture of hepatocellular carcinoma in 23 patients (rupture group) and within 3 months before death of any cause other than rupture of hepatocellular carcinoma in 20 patients with tumor contacting or protruding out of the liver margins (nonrupture group). All the carcinomas in the rupture group were located in the periphery of the liver. They protruded out of the liver margins in 18 cases and contacted the liver margins without protrusion in five cases. For the rupture and nonrupture groups, respectively, mean numbers of involved liver segments were 4.2 +/- 2.3 and 2.3 +/- 1.3 (p less than .01); mean maximal tumor areas were 102.0 +/- 57.0 cm2 and 57.7 +/- 50.9 cm2 (p less than .05); frequencies of tumor protrusion was 78% and 50% (NS); mean maximal lengths of protruded margins of the tumor were 188.1 +/- 81.4 mm and 77.2 +/- 50.3 mm (p less than .01); frequencies of extrahepatic invasion of the tumor were 44% and 20% (NS); and frequencies of ascites were 78% and 50% (NS). No significant differences in age or sex of the patients and clinical stage of the cancer were evident between the two groups. Multiple regression analysis (p less than .005, r2 = .428) indicated that, of the CT findings, maximal length of protrusion correlated best (p less than .05) with subsequent rupture. We conclude that increased tumor size and extent of extrahepatic protrusion are associated with an increased risk for rupture of hepatocellular carcinoma.