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Query: UMLS:C0019204 (hepatocellular carcinoma)
 71,386 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Although there are many complementary and supplementary types of diagnostic imaging of the liver, a logical sequence for most liver pathology begins with high-quality ultrasound. It is noninvasive and inexpensive but very operator dependent. In other settings, CT may be the preferable screening modality, as it gives an excellent picture of the global anatomy and is easily reproducible. Frequently, the two modalities are complementary and indicated; on other occasions, one method will suffice. Radionuclide evaluation of the liver is usually reserved for hepatobiliary imaging for biliary obstruction or the question of acute cholecystitis and tagged-red cell scanning for hemangioma. It is also frequently used for gallium scanning in hepatoma, but lymphoma and inflammatory diseases are also gallium avid. The invasive imaging tests of the liver--angiography and transhepatic and endoscopic retrograde cholangiography--are performed when insufficient information is obtained by the other methods (as in diagnostic transhepatic cholangiography) or when the procedure offers therapy (as for biliary drainage, percutaneous transhepatic removal of common bile duct stones, percutaneous cholecystosis with gallstone dissolution and liver embolization, or the angiographic evaluation for portal shunting or liver resection). The impact of magnetic resonance imaging and fourth-generation raid angiotomography CT scanning has yet to be felt. The use of intraoperative ultrasound is to be encouraged prior to liver resection because it can demonstrate lesions as small as 3 mm in diameter.
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PMID:Current diagnostic imaging modalities of the liver. 264 14

The differential accuracy of ultrasonographic examinations of small hepatic tumours was analyzed by receiver-operating characteristics. Using only one image of a single hepatic tumor under 3 cm in diameter as revealed by real-time scanner, the readers were requested to select one out of five diagnoses (hepatocellular carcinoma, metastatic tumor, cavernous hemangioma, cyst, or miscellaneous) and to choose the credibility from five levels of confidence. The averaged diagnostic accuracy was 68% in hepatocellular carcinoma, 70% in metastatic tumor, and 77% in cavernous hemangioma. Hepatic tumors were classified retrospectively into eight ultrasonographic patterns, based on mutual consent. The mosaic and hypoechoic patterns were relatively characteristic of hepatocellular carcinoma (91% and 92% respectively). Except for these two patterns, ultrasonographic findings in small liver tumors were nonspecific, including frequently reported hyperechoic pattern for cavernous hemangioma.
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PMID:Ultrasonography of small hepatic tumors. 281 56

Two cases of fibrolamellar carcinoma (FLC) of the liver reported here illustrate that this rare neoplasm is a distinct variant of the usual hepatocellular carcinoma (HCC). It occurs in younger individuals, is unrelated to liver cirrhosis and has a remarkably better prognosis due to a higher surgical resectability rate. It is sonographically hyperechoic and demonstrates angiographic and computed tomographic features of a very vascular tumor. The differential diagnosis includes focal nodular hyperplasia, hepatic adenoma, hepatocellular carcinoma and hemangioma.
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PMID:Fibrolamellar carcinoma of the liver: CT, ultrasound and angiography. Case report. 283 79

To evaluate the usefulness of magnetic resonance (MR) imaging in the diagnosis of liver tumors, MR imaging was performed in 70 patients, 30 with normal or cirrhotic liver, 15 with benign tumors and 25 with malignant tumors. MR imaging was carried out with a 0.5-Tesla superconducting magnet and was made using a spin-echo technique, from which T1 and T2-weighted images were obtained, and also T1 and T2 values were measured. Hemangiomas and cysts were demonstrated as sharply circumscribed homogeneous masses of low- or high-intensity on each image. Hepatomas were revealed as low-, iso- and high-intensity masses on both images. The minimum size of hepatoma detected, 1 cm in diameter, exhibited uniform intensity. Large hepatomas showed a mosaic pattern of different intensities, a low-intensity area around the mass, and a capsular pattern. The majority of metastatic tumors demonstrated a characteristic irregularity at the periphery of the mass. There were significant differences in T1 and T2 values between benign and malignant tumors. These results suggest that MR imaging is useful not only in the detection but also in the differentiation of liver tumors and can permit evaluation of the architecture of the tumor.
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PMID:Magnetic resonance imaging in the diagnosis of tumors of the liver. 283 74

Seventy-two patients with hepatocellular carcinoma (hepatoma) and 56 with hemangioma were studied with magnetic resonance (MR) imaging at 0.35 or 1.5 T to evaluate the efficacy of T2 values in differential diagnosis. T2 values were calculated with the two-point method. The mean T2 values of hepatoma and hemangioma were 58.9 msec +/- 8.9 and 101.6 msec +/- 25.8 at 0.35 T and 49.1 msec +/- 9.8 and 85.3 msec +/- 21.2 at 1.5 T. The difference in the T2 values for hepatoma and hemangioma was statistically significant (P less than .001) at both 0.35 and 1.5 T. Fifty-three of 56 lesions (94.6%) at 0.35 T and 86 of 102 lesions (84.3%) at 1.5 T were correctly classified when the T2 borderline between hepatoma and hemangioma was set at 80 msec. All misdiagnosed lesions were hemangioma, and all but one were smaller than 2 cm. However, over 90% of lesions smaller than 2 cm were correctly diagnosed when 70 msec at 0.35 T and 60 msec at 1.5 T were used as borderline T2 values. MR imaging with T2 measurement was very useful for differentiating between hepatoma and hemangioma (including small lesions) at 1.5 T as well as at 0.35 T.
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PMID:Hepatocellular carcinoma and cavernous hemangioma: differentiation with MR imaging. Efficacy of T2 values at 0.35 and 1.5 T. 284 16

Hepatocellular carcinoma (HCC), a common malignancy in the United States with poor prognosis, must be differentiated from hemangioma, focal fat, metastases, and regenerating nodules. Serum alpha-fetoprotein (AFP) levels are not a sensitive method for detection of HCC. High resolution ultrasound has been highly effective in detecting HCC in Japan and Taiwan. Doppler ultrasound can be used to increase the specificity. We review the roles of angiography, computed tomography (CT), and magnetic resonance, to conclude that the Japanese experience has demonstrated the efficacy of screening for HCC in the population at risk using serum AFP and ultrasound with the addition of dynamic CT and angiography where indicated. The continuing poor prognosis of patients with HCC in the United States suggests a failure to apply these methods for the early detection of HCC.
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PMID:Diagnostic imaging of hepatocellular carcinoma: progress in noninvasive tissue characterization. 284 92

We describe the sonographic, CT and angiographic findings in 10 cases of hepatocellular carcinoma in which extensive fatty metamorphosis occurred within the tumors. Fatty change was diffuse in smaller tumors (less than 3.5 cm) and focal in larger tumors (greater than 3.5 cm). Fatty metamorphosis characteristically caused a low-attenuation area on CT (less than -10 H) and a highly echogenic area on sonography. The sonographic appearance of small hepatocellular carcinomas with fatty metamorphosis was identical to the findings in cavernous hemangioma or focal fatty change of the liver. CT correctly revealed the presence of fat in these hepatocellular carcinomas. In these cases, hepatic arteriography showed no tumor stain; however, CT arteriography (dynamic CT during injection of contrast medium into the hepatic artery) was useful in showing the tumor, its capsule, and its internal septa. In the diagnosis of large hepatocellular carcinoma, the presence of intratumoral fat is not likely to be problematic, but small tumors that are diffusely infiltrated by fat must be distinguished from such benign conditions as focal fatty change, lipoma, and angiomyolipoma.
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PMID:Fatty metamorphosis in hepatocellular carcinoma: radiologic features in 10 cases. 284 71

Doppler ultrasound detection of the blood flow associated with liver tumours was studied in primary hepatocellular carcinoma as well as in metastatic liver cancer and haemangioma. Doppler signals were detected from 48 of 55 hepatocellular carcinomas (87.3%), seven of 25 metastatic liver cancers (28.0%) and four of 30 haemangiomas (13.3%). The waveforms of Doppler signals were divided into two types: the pulsatile wave, which was detected from hepatocellular carcinoma (in 35 of the 48 with Doppler signals) and metastatic liver cancer (in all seven with positive signals), and the continuous wave, which was seen from hepatocellular carcinoma (41 out of 48) and haemangioma (in all four with signals). In six patients with hepatocellular carcinoma who underwent transcatheter arterial embolization, the pulsatile wave detected before therapy disappeared immediately thereafter and it is possible that this type of wave originates from tumour vessels. In the study of small, hypoechoic, mass lesions appearing in liver cirrhosis, such signals were also demonstrated, even in eight of 10 small hepatocellular carcinomas less than 2 cm in diameter, whilst they were not detected from nine regenerative nodules related to cirrhotic change. In conclusion, the Doppler ultrasound method may be a useful technique in detecting blood flow within liver tumours and may offer the possibility of a differential diagnosis of small tumours.
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PMID:Pulsed Doppler in the diagnosis of small liver tumours. 284 47

The results of Tc-99m-PMT imaging on 100 patients with various malignant and benign hepatic diseases verified histologically (73 hepatocellular carcinoma, 3 liver cell adenoma, 1 cholangiocarcinoma, 5 metastatic liver carcinoma, 2 liver cyst, 12 hemangioma, 1 fatty degeneration, 1 liver regeneration, 1 postoperative liver fibrosis and 1 liver cirrhosis) are reported. All lesions appeared as decreased radioactivity or "cold" defect region on early Tc-99m-PMT imaging, rendering it valuable for the diagnosis of tumor localization. In 92 (95.8%) of the 96 patients with various hepatic tumors and 25 (86.2%) of the 29 patients with small hepatocellular carcinoma (less than 5 cm), the tumors were localized by early Tc-99m-PMT imaging. In 14 of the 73 patients with established hepatocellular carcinoma, the tumors gave greater radioactivity than that of the surrounding liver tissues, whereas in 31 patients the radioactivity of the tumor equalled the normal liver on delayed Tc-99m-PMT imaging (positive rate 61.6%). There was no significant difference between the positive rates of serum AFP level and the tumor size shown by delayed Tc-99m-PMT imaging in hepatocellular carcinomas. The radioactivity in 3 liver cell adenoma patients was similar to the gallbladder. No false positive result was seen in the other malignant and benign hepatic tumors. This study indicates that delayed Tc-99m-PMT imaging is highly specific in the diagnosis of hepatocellular carcinoma.
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PMID:[Delayed Tc-99m-PMT imaging in the specific diagnosis of hepatocellular carcinoma]. 285 79

A solid phase enzyme-linked immunosorbent assay for human immunoreactive gamma-glutamyltranspeptidase(gamma-GTP) was developed. The working range by this assay was from 1 ng to 100 ng. Serum immunoreactive gamma-GTP was significantly elevated in patient with hepatocellular carcinoma and moderate elevation was found in liver cirrhosis. On the other hand, in sera of patients with non neoplastic disease, including acute hepatitis, chronic hepatitis, fatty liver, hemangioma, the immunoreactive gamma-GTP was not significantly elevated. No correlation was found between the serum levels of gamma-GTP determined by enzymatic assay and enzyme-linked immunosorbent assay. In the tissues of hepatocellular carcinoma and metastatic liver tumor, the immunoreactive gamma-GTP contents were also elevated, which were well correlated with the enzyme contents in sera. When immunohistochemical study was carried out, the immunoreactive gamma-GTP was detected diffusely not only in the cell membrane and bile canaliculi but also in the cytoplasm of cancer cell. These results suggest that the hepatoma tissues contain an immunologically active, but enzymatically inactive form of gamma-GTP enzyme.
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PMID:[Measurement of human serum and liver tissue immunoreactive gamma-glutamyl transpeptidase in patients with various liver diseases]. 289 51


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