Radiological assessment of hepatic vein invasion by hepatocellular carcinoma using combined computed tomography hepatic arteriography and computed tomography arterial portography.
OBJECTIVE
The aim of this study was to elucidate computed tomography hepatic arteriography (CTHA) and CT arterial portography (CTAP) findings characteristic of hepatocellular carcinoma (HCC) with large hepatic venous invasion (HVI) and then to examine whether the presence of minute HVI can be diagnosed based on each finding.


METHODS
Combined CTHA and CTAP of 106 HCCs were examined. Two radiologists analyzed the radiological findings of five nodules with large HVI (group vv2). The remaining 101 nodules were classified into two groups: group vv1, positive minute HVI; group vv0, negative HVI. They examined whether each finding observed in group vv2 could be detected in groups vv1 and vv0.


RESULTS
Analysis of group vv2 identified (a) tumor thrombus, (b) early inflow of the contrast into the hepatic vein proximal to the invaded site, and (c) partially decreased portal venous flow in the peripheral parenchyma subject to the involved hepatic vein. Findings (b) and (c) were observed in 16% of group vv1. A significant difference in frequency of finding (c) was obtained between groups vv1 and vv0. The positive and negative predictive values of finding (c) were 66.7% and 77.9%, respectively.


CONCLUSIONS
Findings (b) and (c), especially the latter, may partly contribute to the radiological diagnosis of minute HVI.
Nishie
Akihiro
A
Department of Clinical Radiology, Graduate School of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Higashi-ku, Fukuoka, 812-8582, Japan. anishie@radiol.med.kyushu-u.ac.jp
Tajima
Tsuyoshi
T
Asayama
Yoshiki
Y
Ishigami
Kousei
K
Hirakawa
Masakazu
M
Ushijima
Yasuhiro
Y
Kakihara
Daisuke
D
Okamoto
Daisuke
D
Fujita
Nobuhiro
N
Taketomi
Akinobu
A
Yoshimitsu
Kengo
K
Honda
Hiroshi
H
D000368:Aged; D006528:Carcinoma, Hepatocellular / Q000000981:diagnostic imaging*; D003287:Contrast Media; D005260:Female; D006503:Hepatic Veins / Q000000981:diagnostic imaging*; D006801:Humans; D007479:Iopamidol; D008113:Liver Neoplasms / Q000000981:diagnostic imaging*; D008297:Male; D008875:Middle Aged; D009361:Neoplasm Invasiveness / Q000000981:diagnostic imaging; D015588:Observer Variation; D011172:Portography / Q000379:methods; D011856:Radiographic Image Enhancement / Q000379:methods; D012189:Retrospective Studies; D014057:Tomography, X-Ray Computed / Q000379:methods*; D019043:Vascular Neoplasms / Q000000981:diagnostic imaging*
D003287:Contrast Media; D007479:Iopamidol