Differentiation of hypervascular hepatic pseudolesions from hepatocellular carcinoma: value of single-level dynamic CT during hepatic arteriography

Area of Science:

• Radiology
• Hepatobiliary Imaging
• Diagnostic Imaging

Background:

• Distinguishing hypervascular hepatocellular carcinoma (HCC) from pseudolesions is crucial for appropriate patient management.
• Hypervascular pseudolesions can mimic HCC on imaging, leading to diagnostic challenges.

Purpose of the Study:

• To evaluate the effectiveness of single-level dynamic CT during hepatic arteriography (D-CTA) in differentiating hypervascular HCC from pseudolesions.
• To identify imaging characteristics on D-CTA that distinguish HCC from pseudolesions.

Main Methods:

• A retrospective analysis of D-CTA findings was conducted in nine patients with HCC and nine patients with pseudolesions.
• D-CTA imaging was performed to assess contrast material enhancement patterns within the lesions and surrounding liver parenchyma.

Main Results:

• Pseudolesions exhibited a three-phase enhancement pattern: portal venous inflow, lesion staining, and fading.
• Hepatocellular carcinoma demonstrated a four-phase enhancement pattern, including tumor staining, adjacent liver inflow, and coronal stain of adjacent liver.
• A characteristic coronal stain of the adjacent liver was observed in all HCC cases but was absent in pseudolesions.

Conclusions:

• Dynamic CT during hepatic arteriography (D-CTA) serves as a valuable tool for differentiating hypervascular HCC from pseudolesions.
• The distinct enhancement patterns, particularly the coronal stain, on D-CTA aid in accurate diagnosis.