CT of fibrolamellar hepatocellular carcinoma

We retrospectively evaluated 10 patients with pathologically proven fibrolamellar hepatocellular carcinoma (FLHCC) to assess the utility of CT (n = 9), ultrasound (n = 10), angiography (n = 9), and MR (n = 3). The tumors were solitary in 6 of 10 patients, well delineated in 7 of 10, and hypervascular in 8 of 10. With use of multimodality imaging techniques, a central scar was demonstrated in 3 of 10 patients, calcifications in 4 of 10, dilated intrahepatic ducts in 2 of 10, thrombosis of a segmental portal branch in 2 of 10, and lymph node involvement in 3 of 10. Computed tomography was the most accurate technique for diagnosis and staging. Magnetic resonance imaging helped establish the correct diagnosis in one patient. This report emphasizes the wide variability of imaging features of FLHCC and the predominant role of CT for suggesting the diagnosis.