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Preoperative Evaluation of Hepatocellular Carcinoma: Combined Use of CT with Arterial Portography and Hepatic Arteriography

Hyun Cheol Kim1,2, Tae Kyoung Kim1, Kyu-Bo Sung1, Hyun-Ki Yoon1, Pyo Nyun Kim1, Hyun Kwon Ha1, Ah Young Kim1, Hyun Jin Kim1 and Moon-Gyu Lee1

1 Department of Radiology, Asan Medical Center, University of Ulsan, 388-1 Poongnap-Dong, Songpa-Ku, Seoul, 138-736, Korea.
2 Present address: Department of Radiology, Cheonan Hospital, Soonchunhyang University, 23-20 Bongmyungdong, Cheonan, Choongnam, 330-721, Korea.



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  		Fig. 1A. —72-year-old man with hepatocellular carcinoma in hepatic segment VI. CT during arterial portogram shows nodular hypoattenuating lesion (arrow) in intraparenchymal area.

 


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  		Fig. 1B. —72-year-old man with hepatocellular carcinoma in hepatic segment VI. Lesion (arrow) is seen as hyperattenuation on CT hepatic arteriogram. At surgery, histopathologic findings revealed hepatocellular carcinoma (not shown).

 


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  		Fig. 2A. —45-year-old man with pseudolesion in hepatic segment II and hepatocellular carcinoma in hepatic segment VIII. CT during arterial portogram shows hypoattenuating wedge-shaped subcapsular lesion (black arrow) in hepatic segment II suspected to be hepatocellular carcinoma. Another large nodular hypoattenuating lesion (white arrows) is seen in hepatic segment VIII.

 


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  		Fig. 2B. —45-year-old man with pseudolesion in hepatic segment II and hepatocellular carcinoma in hepatic segment VIII. Lesion (black solid arrow) in hepatic segment II is seen as hyperattenuation on CT hepatic arteriogram. Lesion (white solid arrows) in hepatic segment VIII is seen as heterogeneous hyperattenuation. Peripheral portal vein branches (open arrow) are well opacified.

 


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  		Fig. 2C. —45-year-old man with pseudolesion in hepatic segment II and hepatocellular carcinoma in hepatic segment VIII. Lesion in hepatic segment II is not seen on follow-up CT scan obtained 20 months after A and B. Large nodular mass (not shown) in hepatic segment VIII was surgically removed and confirmed to be hepatocellular carcinoma.

 


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  		Fig. 3A. —40-year-old man with pseudolesion and hepatocellular carcinoma in hepatic segment V. CT during arterial portogram shows two hypoattenuating lesions adjacent to gallbladder. Anterior lesion (solid arrow) has nodular appearance, and posterior lesion (open arrows) is wedge-shaped.

 


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  		Fig. 3B. —40-year-old man with pseudolesion and hepatocellular carcinoma in hepatic segment V. CT hepatic arteriogram shows hyperattenuation in anterior lesion (arrow) and isoattenuation in posterior lesion. At surgery, anterior lesion was confirmed to be hepatocellular carcinoma and posterior lesion to be pseudolesion.

 


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  		Fig. 4A. —40-year-old man with pseudolesion in hepatic segment V and clinically proven hepatocellular carcinoma in segment III (not shown). CT during arterial portogram shows nodular hypoattenuating subcapsular lesion (solid arrows) in hepatic segment V. Another tiny hypoattenuating subcapsular lesion (open arrow) is noted in same hepatic segment.

 


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  		Fig. 4B. —40-year-old man with pseudolesion in hepatic segment V and clinically proven hepatocellular carcinoma in segment III (not shown). Lesion in segment V is seen as slightly hyperattenuating area on CT hepatic arteriogram (solid arrows) and was prospectively interpreted as hepatocellular carcinoma. Tiny lesion in same hepatic segment is seen as wedge-shaped hyperattenuation (open arrow).

 


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  		Fig. 4C. —40-year-old man with pseudolesion in hepatic segment V and clinically proven hepatocellular carcinoma in segment III (not shown). On follow-up CT scan obtained during hepatic arterial phase 10 months after A and B, neither of two lesions is seen.

 


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  		Fig. 5A. —59-year-old man with hepatocellular carcinoma in hepatic segment IV. CT during arterial portogram shows hypoattenuating wedge-shaped subcapsular lesion (arrows).

 


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  		Fig. 5B. —59-year-old man with hepatocellular carcinoma in hepatic segment IV. CT hepatic arteriogram obtained at same level as A shows subtle hyperattenuating lesion (solid arrows) initially interpreted as pseudolesion, such as arterioportal shunt, at our institution. Lesion was surgically removed and confirmed to be hepatocellular carcinoma. Another suspicious-appearing wedge-shaped hyperattenuating area in hepatic segment IV (open arrows) is possibly due to nontumorous hemodynamic change.

 

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