Skip to main content

Advertisement

SpringerLink
Log in

Outcome of small liver nodules detected by computed tomographic angiography in patients with hepatocellular carcinoma

  • Original Article
  • Published:
Hepatology International Aims and scope Submit manuscript

Abstract

Purpose

Hepatic lesions identified by computed tomography (CT) during arterial portography (CTAP) or CT hepatic arteriography (CTHA) in hepatocellular carcinoma (HCC) patients are sometimes too small to be diagnosed as HCC. We undertook this cohort study to assess whether these small lesions are actually HCC, and to clarify the effectiveness of these imaging examinations in a clinical setting.

Methods

We assessed the characteristics of 74 tiny lesions detected by CTAP and/or CTHA, but not by CT in 67 patients.

Results

Seven out of 10 nodules were histologically confirmed as HCC and 18 out of 64 lesions increased in size and showed typical findings of HCC during the follow-up period. Multivariate analysis revealed that the size of the main tumor (>30 mm in diameter) was associated with the presence of tiny additional HCC lesions (P = 0.002).

Conclusions

These findings indicate that CTAP and CTHA are recommended for determining the stage of HCC, especially when the HCC nodule is larger than 30 mm in diameter.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2

Similar content being viewed by others

References

  1. Parkin DM, Brary F, Ferlay J, Pisani P. Estimating the world cancer burden: Globocan 2000. Int J Cancer. 2001;94:153–156

    Article  CAS  PubMed  Google Scholar 

  2. El-Serag HB, Mason AC. Rising incidence of hepatocellular carcinoma in the United States. N Engl J Med. 1999;340:745–750

    Article  CAS  PubMed  Google Scholar 

  3. Bruix J, Barrera JM, Calvet X, Ercilla G, Costa J, Sanchez-Tapias JM, Ventura M, Vall M, Bruquera M, Bru C, Castillo R, Rodes J. Prevalence of antibodies to hepatitis C virus in Spanish patients with hepatocellular carcinoma and hepatic cirrhosis. Lancet. 1989;2:1004–1006

    Article  CAS  PubMed  Google Scholar 

  4. Colombo M, de Franchis R, Del Ninno E, Sangiovanni A, de Fazio C, Tommasini M, Donato MF, Piva A, Di Carlo V, Dioguardi N. Hepatocellular carcinoma in Italian patients with cirrhosis. N Engl J Med. 1991;325:675–680

    Article  CAS  PubMed  Google Scholar 

  5. Tsukuma H, Hiyama T, Tanaka S, Nakao M, Yabuuchi T, Kitamura T, Nakanishi K, Fujimoto I, Inoue A, Yamazaki H, Kawashima T. Risk factors for hepatocellular carcinoma among patients with chronic liver disease. N Engl J Med. 1993;328:1797–1801

    Article  CAS  PubMed  Google Scholar 

  6. Bruno S, Silini E, Crosignani A, Borzio F, Leandro G, Bono F, Asti M, Rossi S, Larghi A, Cerino A, Podda M, Mondelli MU. Hepatitis C virus genotypes and risk of hepatocellular carcinoma in cirrhosis: a prospective study. Hepatology. 1997;25:754–758

    Article  CAS  PubMed  Google Scholar 

  7. Bruix J, Sherman M, Llovet JM, Beaugrand M, Lencioni R, Burroughs AK, Christensen E, Pagliaro L, Colombo M, Rodes J. Clinical management of hepatocellular carcinoma. Conclusions of the Barcelona-2000 EASL conference. European Association for the Study of the Liver. J Hepatol. 2001;35:421–430

    Article  CAS  PubMed  Google Scholar 

  8. Koike Y, Shiratori Y, Sato S, Obi S, Teratani T, Imamura M, Hamamura K, Imai Y, Yoshida H, Shiina S, Omata M. Risk factors for recurring hepatocellular carcinoma differ according to infected hepatitis virus–an analysis of 236 consecutive patients with a single lesion. Hepatology. 2000;32:1216–1223

    Article  CAS  PubMed  Google Scholar 

  9. Shinagawa T, Ohto M, Kimura K, Tsunetomi S, Morita M, Saisho H, Tsuchiya Y, Saotome N, Karasawa E, Miki M, Ueno T, Okuda K. Diagnosis and clinical features of small hepatocellular carcinoma with emphasis on the utility of real-time ultrasonography. A study in 51 patients. Gastroenterology. 1984;86:495–502

    CAS  PubMed  Google Scholar 

  10. Matsuda Y, Yabuuchi I. Hepatic tumors: US contrast enhancement with CO2 microbubbles. Radiology. 1986;161:701–705

    CAS  PubMed  Google Scholar 

  11. Takayasu K, Shima Y, Muramatsu Y, Goto H, Moriyama N, Yamada T, Makuuchi M, Yamasaki S, Hasegawa H, Okazaki N, Hirohasi S, Kishi K. Angiography of small hepatocellular carcinomas: analysis of 105 resected tumors. AJR Am J Roentgenol. 1986;147:525–529

    CAS  PubMed  Google Scholar 

  12. Yoshimatsu S, Inoue Y, Ibukuro K, Suzuki S. Hypovascular hepatocellular carcinoma undetected at angiography and CT with iodized oil. Radiology. 1989;171:343–347

    CAS  PubMed  Google Scholar 

  13. Matsui O, Kadoya M, Kameyama T, Yoshikawa J, Takashima T, Nakamura Y, Unoura M, Kobayashi K, Izumi R, Ida M. Benign and malignant nodules in cirrhotic livers: distinction based on blood supply. Radiology. 1991;178:493–497

    CAS  PubMed  Google Scholar 

  14. Ikeda K, Saitoh S, Koida I, Tsubota A, Arase Y, Chayama K, Kumada H. Imaging diagnosis of small hepatocellular carcinoma. Hepatology. 1994;20:82–87

    Article  CAS  PubMed  Google Scholar 

  15. Kanematsu M, Oliver JH 3rd, Carr B, Baron RL. Hepatocellular carcinoma: the role of helical biphasic contrast-enhanced CT versus CT during arterial portography. Radiology. 1997;205:75–80

    CAS  PubMed  Google Scholar 

  16. Valls C, Lopez E, Guma A, Gil M, Sanchez A, Andia E, Serra J, Moreno V, Figueras J. Helical CT versus CT arterial portography in the detection of hepatic metastasis of colorectal carcinoma. AJR Am J Roentgenol. 1998;170:1341–1347

    CAS  PubMed  Google Scholar 

  17. Baron RL, Oliver JH 3rd, Dodd GD 3rd, Nalesnik M, Holbert BL, Carr B. Hepatocellular carcinoma: evaluation with biphasic, contrast-enhanced, helical CT. Radiology. 1996;199:505–511

    CAS  PubMed  Google Scholar 

  18. Hwang GJ, Kim MJ, Yoo HS, Lee JT. Nodular hepatocellular carcinomas: detection with arterial-, portal-, and delayed-phase images at spiral CT. Radiology. 1997;202:383–388

    CAS  PubMed  Google Scholar 

  19. Chezmar JL, Bernardino ME, Kaufman SH, Nelson RC. Combined CT arterial portography and CT hepatic angiography for evaluation of the hepatic resection candidate. Work in prognosis. Radiology. 1993;189:407–410

    CAS  PubMed  Google Scholar 

  20. Irie T, Takeshita K, Wada Y, Kusano S, Terahata S, Tamai S, Hatsuse K, Aoki H, Sugiura Y. CT evaluation of hepatic tumors: comparison of CT with arterial portography, CT with infusion hepatic arteriography, and simultaneous use of both techniques. AJR Am J Roentgenol. 1995;164:1407–1412

    CAS  PubMed  Google Scholar 

  21. Murakami T, Oi H, Hori M, Kim T, Takahashi S, Tomoda K, Narumi Y, Nakamura H. Helical CT during arterial portography and hepatic arteriography for detecting hypervascular hepatocellular carcinoma. AJR Am J Roentgenol. 1997;169:131–135

    CAS  PubMed  Google Scholar 

  22. Kanematsu M, Hoshi H, Imaeda T, Murakami T, Inaba Y, Yokoyama R, Nakamura H. Detection and characterization of hepatic tumors: value of combined helical CT hepatic arteriography and CT during arterial portography. AJR Am J Roentgenol. 1997;168:1193–1198

    CAS  PubMed  Google Scholar 

  23. Jang HJ, Lim JH, Lee SJ, Park CK, Park HS, Do YS. Hepatocellular carcinoma: are combined CT during arterial portography and CT hepatic arteriography in addition to triple-phase helical CT all necessary for preoperative evaluation? Radiology. 2000;215:373–380

    CAS  PubMed  Google Scholar 

  24. Kim TK, Choi BI, Han JK, Chung JW, Park JH, Han MC. Nontumorous arterioportal shunt mimicking hypervascular tumor in cirrhotic liver: two-phase spiral CT findings. Radiology. 1998;208:597–603

    CAS  PubMed  Google Scholar 

  25. Lim JH, Kim EY, Lee WJ, Lim HK, Do YS, Choo IW, Park CK. Regenerative nodules in liver cirrhosis: findings at CT during arterial portography and CT hepatic arteriography with histopathologic correlation. Radiology. 1999;210:451–458

    CAS  PubMed  Google Scholar 

  26. Yuki K, Hirohashi S, Sakamoto M, Kanai T, Shimosato Y. Growth and spread of hepatocellular carcinoma. A review of 240 consecutive autopsy cases. Cancer. 1990;66:2174–21749

    Article  CAS  PubMed  Google Scholar 

  27. Imai Y, Murakami T, Hori M, Fukuda K, Kim T, Marukawa T, Abe H, Kuwabara M, Onishi H, Tsuda K, Sawai Y, Kurokawa M, Hayashi N, Monden M, Nakamura H. Hypervascular hepatocellular carcinoma: combined dynamic MDCT and SPIO-enhanced MRI versus combined CTHA and CTAP. Hepatol Res. 2008;38:147–158

    PubMed  Google Scholar 

  28. Bluemke DA, Sahani D, Amendola M, Balzer T, Breuer J, Brown JJ, Casalino DD, Davis PL, Francis IR, Krinsky G, Lee FT Jr, Lu D, Paulson EK, Schwartz LH, Siegelman ES. Efficacy and Safety of MR Imaging with Liver-specific Contrast Agent: U.S. Multicenter Phase III Study. Radiology. 2005;237:89–98

    Article  PubMed  Google Scholar 

  29. Hammerstingl R, Huppertz A, Breuer J, Balzer T, Blakeborough A, Carter R, Fusté LC, Heinz-Peer G, Judmaier W, Laniado M, Manfredi RM, Mathieu DG, Müller D, Mortelè K, Reimer P, Reiser MF, Robinson PJ, Shamsi K, Strotzer M, Taupitz M, Tombach B, Valeri G, van Beers BE, Vogl TJ. Diagnostic efficacy of gadoxetic acid (Primovist)-enhanced MRI and spiral CT for a therapeutic strategy: comparison with intraoperative and histopathologic findings in focal liver lesions. Eur Radiol. 2008;18:457–467

    Article  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Gastroenterology and Hepatology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, 2-5-1 Shikata-cho, Okayama, Okayama, 700-8558, Japan

    Hideki Ohnishi, Kohsaku Sakaguchi, Kazuhiro Nouso, Yoshiyuki Kobayashi, Shinichiro Nakamura, Hironori Tanaka, Yasuhiro Miyake, Bon Shoji, Shouta Iwadou & Yasushi Shiratori

Authors
  1. Hideki Ohnishi
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Kohsaku Sakaguchi
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Kazuhiro Nouso
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Yoshiyuki Kobayashi
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Shinichiro Nakamura
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Hironori Tanaka
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Yasuhiro Miyake
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Bon Shoji
    View author publications

    You can also search for this author in PubMed Google Scholar

  9. Shouta Iwadou
    View author publications

    You can also search for this author in PubMed Google Scholar

  10. Yasushi Shiratori
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Hideki Ohnishi.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Ohnishi, H., Sakaguchi, K., Nouso, K. et al. Outcome of small liver nodules detected by computed tomographic angiography in patients with hepatocellular carcinoma. Hepatol Int 4, 562–568 (2010). https://doi.org/10.1007/s12072-010-9190-6

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s12072-010-9190-6

Keywords

Search

Navigation