Hepatocellular carcinoma with venous invasion. Sonographic-angiographic correlation

Ultrasound was correlated with angiography for assessment of tumor extension to the intrahepatic inferior vena cava, hepatic veins, and portal vein branches in 15 cases of hepatocellular carcinoma (HCC) and 85 cases of hepatic metastases. Sonography revealed intraluminal tumor thrombus in 5 cases of HCC (33%), which were confirmed by angiography (sensitivity and specificity = 100%), and in 1 case of hepatic metastases (1%). Sonography was superior in depicting veins obscured or nonopacified on angiography, which in turn demonstrated arteriovenous shunting not appreciated on sonography. Used as the initial procedure for evaluation of venous extension of HCC, ultrasound can suggest the histology (though this must be confirmed by biopsy) and determine the feasibility of resection.