Title: Evaluation of Patients with Hepatic Masses Using Triphasic Multidetector Computed Tomography and Correlation with Cytohistopathological Findings
Authors: Anil Jangir, R.N. Gehlot, Kirti Chaturvedy, Sunil Dhadhich, Prateek Sihag, Suman, Sachin, Mohit Jakhar
Purpose: The purpose of study was to evaluate the features of various hepatic masses using triple phase multidetector computed tomography and to correlate features of triple phase multidetector computed tomography with cytohistopathological findings. Tumour enhancement subsequent to contrast administration depends on blood supply, thus images are acquired in arterial, portovenous and delayed phases after fixed time interval and helps in characterizing tumours.
Methods: It is a descriptive type of observational study done on 100 patients of hepatic masses on basis of clinical findings or on ultrasonography. Axial, coronal and sagittal images of noncontrast, arterial phase, portovenous and delayed phase were taken and imaging findings were correlates with cytohistopathological findings/USG guided biopsy.
Results: Study was done in 100 patients (n=100). In our study the youngest patient was of 3 years and the oldest was 92 years, with a mean age of 53.8 years. Majority of the patients were in age group of 41-50 & 51-60 years. Out of 100 patients, half of the patients were male and half were females. Hepatic tumors were detected in all 100 patients. Of these 21 were benign and 79 were malignant tumors. Of 100 cases, 45 cases of metastases, 21 cases of HCC, 18 cases of hemangiomas, 10 cases of intrahepatic cholangiocarcinoma, 2 case of biliary cystadenoma, 1 case of biliary cystadenocarcinoma, 1 case of focal nodular hyperplasia, 1 case of hepatoblastoma and 1 case of epithelioid hemangioendothelioma detected.HCC were prevalent in 51-60 years age group, metastases in 41-50 years age group and hemangioma in 31-40 years age group. High male predilection was noted in Hepatocellular carcinoma and metastases, whereas hemangiomas and cholangiocarcinoma were more common in female. Out of 100 cases right lobe was involved in 37 % cases, left lobe in 11% cases and both lobe involvement was noted in 52% cases. In 11(52.4%) cases out of 21 underlying liver parenchyma is cirrhotic and in 10 (47.6%) cases underlying liver parenchyma is normal. In 12(57.2%) cases out of 21 involvement of portal vein/hepatic vein and IVC is seen. In 17(80.9%) cases of HCC out of 21 level of AFP were raised, however in 4 (19.1%) patients serum AFP level were normal.
Conclusions: Hypervascular tumours are better appreciated in arterial phase. Hypovascular tumours are better demonstrated on portovenous phase. Delayed phase helped in demonstrating few tumours like intrahepatic cholangiocarcinoma, hemangioma and HCC. Triple phase MDCT with its arterial, portovenous inflow (late arterial) and portovenous phases is an ideal modality for diagnosis and characterization of HCC. It is helpful to provide additional information like vascular invasion, capsular delineation, arterioportal shunts and also provide a vascular road map for surgery and image guided interventions. Pediatric malignant tumors like hepatoblastoma are diagnosed and managed with help of important information provided by triple phase MDCT. Cholangiocarcinoma is diagnosed in delayed phase images acquired during triple phase MDCT protocol. Metastases could be differentiated as hyper or hypovascular type based on triple phase CT characteristics. This further helps to define primary lesion. Compared to other imaging modalities MDCT provides substantial amount of information regarding hepatic tumours and surrounding structures hence it has carved a niche for being a superb diagnostic and follow up modality.
Keywords: Hepatocellular carcinoma, Cholangiocarcinoma, Epithelioid hemangioendothelioma, Biliary cystadenoma /cystadenocarcinoma & Diffuse hepatic hemangiomatosis.