Liverlesions
Begins at about 3-4 minutes after contrast injection and imaging is best done at 10 minutes
Valuable for washout of contrast(HCC),retention of contrast(heamangioma),retention of contrast in fibrous tissue (capsule of HCC, central scar of FNH)
7. Powerpoint Templates
Understanding the
phases
Page 7
• Liver has dual blood supply
• Normal parenchyma is supplied for 80%
by the portal vein and only for 20% by the
hepatic artery
• All liver tumors get 100% of their blood
supply from the hepatic artery
8. Powerpoint Templates
Arterial phase
Page 8
• In the arterial phase hypervascular tumors
will enhance via the hepatic artery, when
normal liver parenchyma does not yet
enhances, because contrast is not yet in
the portal venous system.
• Hypervascular tumors will enhance
optimally at 35 sec after contrast injection
11. Powerpoint TemplatesDelayed
Phase
Page
11
• Begins at about 3-4 minutes after contrast
injection and imaging is best done at 10 minutes
• Valuable for washout of contrast(HCC),retention
of contrast(heamangioma),retention of contrast
in fibrous tissue (capsule of HCC, central scar of
FNH)
15. Powerpoint Templates
Hepatocellular Carcinoma
Page
15
• Most common primary malignancy of the
liver
• Third most common cause of cancer-
related death
• The incidence of HCC is rising, largely
attributed to a rise in hepatitis C infection
16. Powerpoint Templates
Risk
factors:
Page
16
• hepatitis B (HBV) infection
• hepatitis C (HCV) infection
• alcoholism
• biliary cirrhosis
• food toxins e.g. aflatoxins
• congenital biliary atresia
• inborn errors of metabolism
haemochromatosis
alpha-1 antitrypsin deficiency
type 1 glycogen storage disease
Wilson disease
19. Powerpoint Templates
• Majority of patient have cirrhosis
• More than 80% of patients with HCC have
cirrhosis
• May be Focal, multiple or diffusely
infiltrative
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19
21. Powerpoint TemplatesUltrasou
nd
Page
21
• Variable appearance
• Small <3cm usually hypoechoic
• Larger tumors often are heterogeneous
• May invade the portal vein
• Most tumors will show central vascularity
on Doppler study
25. Powerpoint TemplatesC
T
Page
25
• Focal HCC
large usually hypodense mass
may have necrosis / fat / calcification
• Multifocal HCC
multiple masses of variable attenuation may also
have central hypodense necrotic portions
• Diffuse HCC
may be difficult to distinguish from associated
cirrhosis
33. Powerpoint Templates
Fibrolamellar hepatocellular carcinoma
• Variant of HCC
• Younger age group(20-40years)
• Not associiated with cirrhosis
• No association with HCC risk factors
• Usually present with constitutional
symptoms
• Fibrollamellllar carcinomas typically are
singlle llarge ttumours Page
33
35. Powerpoint Templates
C
T
Page
35
• Large solitary well circumscribed
• Heterogeneous arterial enhancement
• 30-40% have central scar
• Calcification can be seen on non
enhanced CT
48. Powerpoint Templates
C
T
Page
48
• On unenhanced CT -> Hypodense
• On Enhanced CT -> non enhancing
hypodense
• The margin of the lesions can vary from
well defined to ill defined
• Hyperattenuating lesions are uncommon