Hepatic lesion characterization in cirrhosis: significance of arterial hypervascularity on dual-phase helical CT
1Department of Radiological Sciences, UCLA Medical Center 90095, USA.
Insights
The presence of arterial hypervascularity in liver lesions of cirrhotic patients is a strong indicator of hepatocellular carcinoma (HCC). Dual-phase helical CT can accurately identify these hypervascular lesions, improving diagnostic confidence.
Area of Science:
- Hepatology
- Radiology
- Oncology
Background:
- Cirrhosis significantly increases the risk of developing liver cancer.
- Accurate diagnosis of hepatic lesions in cirrhotic patients is crucial for treatment planning and prognosis.
Purpose of the Study:
- To assess the diagnostic value of arterial hypervascularity on dual-phase helical CT for identifying malignant liver lesions in cirrhotic patients.
- To correlate the presence and pattern of hypervascularity with histopathologic findings.
Main Methods:
- Prospective identification of 58 liver lesions (>1 cm) in 26 cirrhotic patients undergoing preoperative evaluation for liver transplantation.
- Retrospective review of dual-phase helical CT arterial phase scans to categorize lesions based on arterial hypervascularity.
- Correlation of radiologic findings with histopathologic or clinical diagnoses.
Main Results:
- Arterial hypervascularity was present in 37 of 58 lesions, all of which were hepatocellular carcinoma (HCC) (100% positive predictive value).
- Of the 21 hypovascular lesions, 17 were HCC and 4 were benign (81% positive predictive value).
- The presence of arterial hypervascularity was a statistically significant predictor of HCC (p < .05).
Conclusions:
- The presence of hypervascularity in hepatic masses in cirrhotic patients is highly predictive of malignancy, specifically HCC.
- Dual-phase helical CT is a valuable tool for diagnosing HCC in this patient population.
- Arterial hypervascularity patterns did not correlate with histologic grading.
Objective:
Our goal was to evaluate the diagnostic significance of the presence and pattern of arterial hypervascularity in lesions detected on dual-phase helical CT in cirrhotic patients.
Materials And Methods:
Fifty-eight lesions greater than 1 cm in size were prospectively identified in 26 patients with end-stage liver disease who had undergone dual-phase helical CT for preoperative liver transplantation evaluation. All 26 patients had diagnoses proven by histologic evaluation or by clinical criteria. All arterial phase scans were retrospectively reviewed and lesions were categorized for the presence and pattern of arterial hypervascularity. Radiologic findings were correlated with histopathologic data.
Results:
Thirty-seven of the 58 lesions had hypervascular components on arterial phase scans. All 37 of these lesions were found to represent hepatocellular carcinoma (HCC) (positive predictive value, 100%). Of the 21 remaining hypovascular lesions, 17 were HCC and four were benign (positive predictive value, 81%). Of the nine patients in whom all lesions were hypovascular, six had HCC (positive predictive value, 66%). The value of the presence of arterial hypervascularity for diagnosing HCC was statistically significant (p < .05). However, the presence or absence of arterial hypervascularity and the specific enhancement pattern revealed by helical CT did not correlate with histologic grading.
Conclusion:
The presence of hypervascularity in hepatic masses found in cirrhotic patients is highly predictive of malignancy.
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