Diagnostic Ultrasound - Abdomen and Pelvis

Hepatocellular Carcinoma
Diagnoses: Liver
TERMINOLOGY
• Hepatocellular carcinoma (HCC)
• Synonyms: Hepatoma, primary liver cancer
IMAGING
• US: Solid, intrahepatic mass in patient with risk factors such
as chronic hepatitis or cirrhosis
• Contrast-enhanced CT, MR, or US: Shows characteristic late
arterial phase hyperenhancement and portal venous or
delayed phase washout (hypoenhancement compared to
adjacent liver parenchyma)
• Portal vein or hepatic vein tumor invasion highly suggestive
of HCC
TOP DIFFERENTIAL DIAGNOSES
• Regenerative or dysplastic nodule
• Hepatic hemangioma
• Focal nodular hyperplasia
• Hepatic adenoma
KEY FACTS
• Metastases
PATHOLOGY
• Primary malignancy of liver arising from hepatocytes
• Risk factors
○ Cirrhosis (60-90%): Due to chronic viral hepatitis (HBV,
HCV), alcoholic cirrhosis
○ HCV patients typically cirrhotic; HBV patients often not
cirrhotic
CLINICAL ISSUES
• Treatment includes surgical resection, RF ablation, intraarterial
chemoembolization or radioembolization, liver
transplant, sorafenib, or external beam radiation
DIAGNOSTIC CHECKLIST
• Any solid mass > 1 cm detected in cirrhotic liver is suspicious
for HCC until proven otherwise
(Left) Graphic shows a
heterogeneous, hypervascular
hepatocellular carcinoma .
Numerous adjacent satellite
nodules ſt as well as portal
vein invasion are depicted.
Underlying liver disease is
evident given the nodular liver
capsule st and ascites .
(Right) Longitudinal grayscale
ultrasound of the liver shows a
hypoechoic, solid
hepatocellular carcinoma ſt.
In the setting of chronic
hepatitis, this is highly
suspicious for HCC and should
be further characterized with
contrast-enhanced CT or
contrast-enhanced MR.
(Left) Transverse grayscale
ultrasound of the liver shows a
slightly hyperechoic, solid
hepatocellular carcinoma st
with a hypoechoic halo and
slight posterior acoustic
enhancement ſt, occasionally
seen with hepatocellular
carcinoma. (Right) Color
Doppler ultrasound of the
same patient shows
detectable internal vascularity
st in the hepatocellular
carcinoma.
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