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Diffuse infiltrative hepatocellular carcinoma: Multimodality imaging manifestations.

Seyedeh Panid Madani1, Mohammad Mirza-Aghazadeh-Attari1, Alireza Mohseni1

  • 1Russell H. Morgan Department of Radiology and Radiological Science, School of Medicine, Johns Hopkins Hospital, Johns Hopkins University, Baltimore, Maryland, USA.

Journal of Surgical Oncology
|November 14, 2022
PubMed
Summary

Infiltrative hepatocellular carcinoma (HCC), a rare liver cancer subtype, presents subtle imaging features that challenge early detection. Understanding these characteristics is vital for timely diagnosis and improved patient outcomes.

Keywords:
CTMRIcancerhepatocellular carcinomaradiology

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Area of Science:

  • Hepatobiliary imaging
  • Oncology
  • Radiology

Background:

  • Hepatocellular carcinoma (HCC) is a leading cause of cancer death worldwide, often arising in patients with liver cirrhosis.
  • HCC exhibits diverse morphologic subtypes, each with unique clinical and imaging characteristics.
  • Infiltrative HCC, the least common subtype (8-20%), presents as diffuse, ill-defined nodules, making it difficult to distinguish from background cirrhosis.

Purpose of the Study:

  • To review and elucidate the characteristic imaging features of infiltrative HCC.
  • To enhance the diagnostic accuracy of abdominal radiologists in identifying this challenging HCC subtype.
  • To emphasize the importance of recognizing infiltrative HCC for timely intervention and improved prognosis.

Main Methods:

  • Review of cross-sectional imaging findings (ultrasonography and MRI) in infiltrative HCC.
  • Analysis of T1-weighted and T2-weighted MRI signal intensities and lesion boundaries.
  • Comparison of imaging presentation with background hepatic cirrhosis.

Main Results:

  • Infiltrative HCC appears as ill-defined, heterogeneous areas on ultrasonography, mimicking cirrhosis.
  • On MRI, it typically presents as a poorly defined region with aberrant signal intensity, often hypointense on T1 and hyperintense on T2-weighted images.
  • The lack of clear boundaries on cross-sectional imaging contributes to delayed diagnosis and advanced-stage presentation.

Conclusions:

  • Infiltrative HCC poses diagnostic challenges due to its subtle and diffuse nature on imaging.
  • Radiologists must be vigilant in identifying specific imaging patterns to differentiate infiltrative HCC from benign cirrhotic changes.
  • Early recognition of infiltrative HCC imaging features is critical for improving patient prognosis and treatment strategies.