title: Hepatocellular carcinoma in chronic hepatitis C in the absence of advanced fibrosis or cirrhosis.
abstract: OBJECTIVE
  The objective of our study was to describe the cross-sectional imaging appearance of hepatocellular carcinoma (HCC) in patients with chronic hepatitis C virus (HCV) infection in the absence of advanced fibrosis and cirrhosis.
  
  
  METHODS
  This study is a retrospective review of our surgical database to identify patients with chronic HCV infection and HCC who underwent hepatectomy and who had undergone preoperative CT or MRI. Only patients with a Metavir fibrosis score of F0, F1, or F2 on pathology were included. Patients with hepatitis B virus coinfection or other causes of chronic liver disease and patients with histopathologic evidence of advanced fibrosis or cirrhosis (Metavir scores F3 and F4) were excluded. Contrast-enhanced CT or MRI examinations performed within 2 months before surgery were reviewed for the number, size, and location of tumors; tumor enhancement characteristics; and presence of macrovascular invasion.
  
  
  RESULTS
  Two hundred forty-five resections of HCC in patients with HCV were performed in our institution from 1987 to 2012. Of this group, 26 patients (10.6%) had a Metavir fibrosis score of F0, F1, or F2; of those patients, 19 (18 men and one woman; 18 non-Asian patients and one Asian patient; mean age, 64 years) had imaging studies available for review. Twenty-one HCCs (mean size, 4.5 cm; range, 0.9-14.8 cm) were evaluated at imaging. Typical wash-in and washout characteristics were seen in 16 of 19 viable lesions (84.2%). The remaining two HCCs were completely necrotic after transarterial chemoembolization. Eighteen patients had a solitary tumor. Most tumors (15/21, 71.4%) developed in the right hepatic lobe.
  
  
  CONCLUSIONS
  HCC can develop in patients with chronic HCV without advanced fibrosis or cirrhosis, most frequently in older non-Asian men, and usually appears as a large solitary tumor with a typical wash-in-washout enhancement pattern.
authors.affiliation: Department of Radiology/Body MRI and Translational and Molecular Imaging Institute, Ichan School of Medicine at Mount Sinai, One Gustave Levy Pl, Box 1234, New York, NY 10029, USA.
authors.forename: Sara
authors.initials: S
authors.lastname: Lewis
authors.forename: Sasan
authors.initials: S
authors.lastname: Roayaie
authors.forename: Stephen C
authors.initials: SC
authors.lastname: Ward
authors.forename: Inna
authors.initials: I
authors.lastname: Shyknevsky
authors.forename: Ghalib
authors.initials: G
authors.lastname: Jibara
authors.forename: Bachir
authors.initials: B
authors.lastname: Taouli
mesh_terms: D006528:Carcinoma, Hepatocellular / Q000175:diagnosis / Q000000981:diagnostic imaging / Q000821:virology*; D003287:Contrast Media; D005260:Female; D006498:Hepatectomy; D019698:Hepatitis C, Chronic / Q000150:complications*; D006801:Humans; D007090:Image Interpretation, Computer-Assisted; D008103:Liver Cirrhosis; D008113:Liver Neoplasms / Q000175:diagnosis / Q000000981:diagnostic imaging / Q000821:virology*; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D014057:Tomography, X-Ray Computed
chemical_list: D003287:Contrast Media