Features of Hepatocellular Carcinoma
HCC (hepatocellular Carcinoma) can be solitary, multifocal or diffuse
Diffuse form is seen mostly in the west and other two in asia
HCC invades portal vein in about 40% cases and IVC and hepatic veins in 15%
Ultrasound-
Sensitivity - 75 to 94%
Hypoechoic with heterogenous architecture
Encapsulated HCC can appear as isoechoic with hypoechoic rim
Portal vein and Hepatic vein thrombosis
Contrast Enhanced Ultrasound
Contrast used is Levovist or Mn-DPDP (Manganese dipyridoxyldiphosphate)
Increased echogenicity in the arterial phase and washout in portal phase
CT scan
Arterial phase shows enhancement with hypodense rim
Portal phase rapid wash out and lesion becomes iso dense or hypodense to the liver parenchyma
MRI
Hypointense on T1W and Hyperintense in T2W. Haemorrhage can increase intensity in T1W
Gadolinium scan - arterial phase intense enhancement
Intrahepatic Cholangiocarcinoma
Japanese Liver cancer study group has classified it as
Mass forming, Periductal infiltrating and intraductal growing
Ultrasound-
Well defined homogenous mass can have satellite nodules in 10-20%
Central scar 30%
CT Scan
Rim or Band like peipheral nodular enhancement in arterial and venous pahse
In delayed phase there is progressive and concentric filling
MRI
Similar findings to CT above
Capsular retractrion, dilatation and thickening of bile ducts
