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CC BY-NC-ND 4.0 · Indian J Radiol Imaging
DOI: 10.1055/s-0044-1789191
Original Article

Multiphasic Computed Tomography Enhancement Characteristics and Utility of Delayed Phase in Infiltrative Hepatocellular Carcinoma

Tarvinder Singh
1   Department of Radiodiagnosis, Postgraduate Institute of Medical Education and Research, Chandigarh, India
,
Nandita Mehta
1   Department of Radiodiagnosis, Postgraduate Institute of Medical Education and Research, Chandigarh, India
,
Pankaj Gupta 
1   Department of Radiodiagnosis, Postgraduate Institute of Medical Education and Research, Chandigarh, India
,
Ajay Gulati
1   Department of Radiodiagnosis, Postgraduate Institute of Medical Education and Research, Chandigarh, India
,
Mudita Gulati
1   Department of Radiodiagnosis, Postgraduate Institute of Medical Education and Research, Chandigarh, India
,
Naveen Kalra 
1   Department of Radiodiagnosis, Postgraduate Institute of Medical Education and Research, Chandigarh, India
,
Madhumita Premkumar
2   Department of Hepatology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
,
Sunil Taneja
2   Department of Hepatology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
,
Vaneet Jearth
3   Department of Gastroenterology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
,
Vishal Sharma 
3   Department of Gastroenterology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
,
Ajay Duseja
2   Department of Hepatology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
› Author Affiliations Funding None.
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Abstract

Objective The aims of this study are to compare the multiphasic contrast-enhanced computed tomography (CECT) characteristics of infiltrative hepatocellular carcinoma (HCC) with nodular HCC and to assess the conspicuity of infiltrative HCC on different phases of CECT.

Materials and Methods This retrospective study comprised consecutive treatment-naive cirrhotic patients diagnosed with infiltrative and nodular HCC between January 2020 and December 2021 based on a multiphasic CECT (comprising arterial, portal venous, and delayed phases). The diagnosis of HCC was based on the Liver Imaging Reporting and Data System (LI-RADS) v2018 criteria (LR-4 and LR-5 lesions). Infiltrative HCCs are characterized by large, irregular, permeative lesions spread over multiple liver segments or lobes. Nodular HCCs comprise well-defined tumor nodules. Two radiologists independently reviewed all CT images. Additionally, lesion conspicuity on the arterial, portal venous, and delayed phases was assessed.

Results One hundred fifty-eight patients (117 nodular and 41 infiltrative HCCs; mean age: 55.6 ± 17.2 years; 90 [56.9%] males) were included. Arterial phase hyperenhancement, portal venous/delayed phase washout, and delayed phase enhancing capsule were significantly associated with nodular HCCs (p = 0.002, 0.0001, and <0.0001, respectively). Portal vein, hepatic vein thrombosis, biliary dilatation, and ascites were significantly associated with infiltrative HCCs (p < 0.0001, 0.004, <0.0001, and 0.003, respectively). The interobserver agreement for the conspicuity of infiltrative HCC was the highest for the delayed phase (weighted kappa = 0.611).

Conclusion Infiltrative HCCs show the major LI-RADS features less frequently compared with nodular HCCs, and venous thrombosis is an important clue to the diagnosis. The delayed phase of multiphasic CECT is critical to identifying these lesions.

Keywords

CT - hepatocellular carcinoma - LI-RADS - portal vein thrombosis


Publication History

Article published online:
14 August 2024

© 2024. Indian Radiological Association. This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/)

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