Abstract of paper presented in Asia Pacific Congress for Study of Liver (APASL,2004,N.Delhi)
HEPATO CELULLAR CARCINOMA : MULTIPHASIC CT EVALUATION IN 27 PATIENTS
H. S. Das, N. Medhi, P. K. Sarma, P. Goswami, P. Hazarika, B. Sarma
Primus Imaging, G. S. Road
Hepato cellular carcinoma ( HCC) is the eight most common malignancy worldwide and represents 6 % of all tumors. It is also the most common primary hepatic malignancy. Increased incidence of HCC is seen in the Far East, Southeast Asia and sub-Saharan Africa ( 90 cases per 1,00,000 population versus 2.4 cases per 100,000 in the United States.
Risk factors for developing HCC includes cirrhosis, hepatitis B and C viruses. Additional risk factors include haemochromatosis, excessive androgens, ∞ 1 antitrypsin deficiency, exposure to oral contraceptives, Thorotrast, aflatoxins and vinyl chloride. Hepatitis B is considered to be the primary cause in 80% of cases worldwide. Peak age of incidence is 50 to 70 yrs with a male predominance of 4:1.
Objective :- To evaluate clinical and multiphasic helical CT findings in 27 patients of hepato cellular carcinomas.
Materials and Methods :- Multiphasic helical CT scans were performed in 27 patients of HCC’s. Non ehanced scans were obtained in all patients, along with hepatic arterial dominant phase ( HAP) and portal venous dominant phase (PVP) images at 25-28 and 60-70 seconds after intravenous infusion of 60 to 80 ml of contrast. Delayed sections were also obtained in all the patients after 5 to 10 minutes. We reviewed age, gender, tumor risk factor, serum tumor markers, and tumor morphology with degree and type of enhancement on helical multiphasic CT.
Results : – 22 of the 27 patients ( 81% ) were men. Patients had an age range of 30 to 87 yrs ( mean = 55.9 years ). Abdominal signs and symptoms were present in 25 out of 27 patients ( 92.5 %) and 11 of 27 patients( 40.7 %) had chronic liver disease ( CLD). Abdominal signs and symptoms were present in 24 of 27 patients HCC was proved on the basis of Biopsy (n= 16 ) and by levels of increased serum alpha feto-protein (n=19 ). 15 patients had solitary or dominant mass. At CT well defined tumor was demonstrated in all the patients with signs of malignancy with hepatic hypervascularity ( 96 %), biliary obstruction (10%),satellite lesions (45%) , lymphadenopathy ( 25 %), ascites (18 % ) and
portal venous thrombosis in 11 %. Portions of tumors were heterogeneously hyperattenuating at arterial phase in 27 (100%) and hypoattenuating in portal phase in 24 patients (88 %). Some of the larger tumors showed delayed persistent enhancement in the equilibrium phase (n= 6 ). Most of the tumors were hypoattenuating on the unenhanced images.
Conclusion: In our patients HCC was seen to develop in presence and absence of cirrhosis or known risk factors and typically appeared as large, symptomatic hepatic masses with clinical, laboratory and CT features that helps to identify these tumors from other hepatic masses.