Computed tomography and ultrasonography of hepatoma

Computed tomography (CT) scans and sonograms of 37 patients with hepatocellular carcinoma (hepatoma) were reviewed to determine the characteristics of the tumour and to compare the modalities in terms of accuracy in defining tumour morphology and ability to predict vascular invasion and extrahepatic spread. By CT, slightly over 50% of the tumours were multicentric, about 40% were solitary, and the rest were diffuse. About half of the hepatomas were heterogeneous in density before injection of contrast agent and most became enhanced in a non-uniform manner. In addition, about a quarter of the tumours either became visible or were better seen after injection of contrast agent. At sonography, approximately two-thirds of the neoplasms were thought to be solitary and one-third multicentric. The majority also had a mixed echo texture. Although the lesion was identified in all 13 patients who had both studies, sonography underestimated the extent of hepatic involvement in 38% of the cases. Sonography also failed to demonstrate lymphadenopathy that was detected by CT in two patients. In general, both techniques were effective in identifying vascular invasion. CT was very accurate in showing the extent of hepatic involvement but was unable to identify direct invasion of neighbouring structures. Because each technique has limitations in the evaluation of hepatoma, we believe that both should be performed if curative resection is being considered.