Infiltrative Hepatocellular Carcinoma: What Radiologists Need to Know
Infiltrative Hepatocellular Carcinoma: What Radiologists Need to Know
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DOI：
10.1148/rg.352140114
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发表时间：
2015-03-01
期刊：
影响因子：
5.5
通讯作者：
Tublin, Mitchell E.
中科院分区：
文献类型：
--
作者：
Reynolds, Arich R.;Furlan, Alessandro;Tublin, Mitchell E.
肝细胞癌（HCC）是全球癌症相关死亡的主要原因之一。HCC的宏观生长模式分为三类：结节性、块状和浸润性。浸润性HCC占HCC病例的7%-20%，并且在病理分析中基于微小肿瘤结节在整个肝脏大区域的扩散而得到证实。浸润性肝癌可能是一个诊断挑战，因为在成像时通常很难与肝硬化的背景变化区分开来。浸润性肝癌通常分布在多个肝段，占据整个肝叶或整个肝脏，并且经常与门静脉肿瘤血栓形成有关。肿瘤通常是不明确的超声检查，并显示最低限度的和不一致的动脉增强和不均匀的冲洗在造影剂增强计算机断层扫描和磁共振成像（MR）。在弥散、T1和T2加权成像中，肿瘤在周围肝实质中更明显。几种肝脏疾病可以模仿这种恶性肿瘤的浸润性外观，包括局灶性融合性纤维化、肝脂肪沉积、肝微血管瘤、肝内胆管癌和弥漫性转移性疾病（假肝硬化）。浸润性肝癌患者的预后很差，因为肿瘤通常是明显的进展，并与血管浸润在介绍。手术切除后生存率降低，因此浸润性HCC是切除和移植的禁忌症。了解关键的肿瘤特征和影像学表现将有助于放射科医生制定正确和及时的诊断，以改善患者的管理。(C)RSNA，2015年
Hepatocellular carcinoma (HCC) is one of the leading causes of cancer-related death worldwide. The macroscopic growth pattern of HCC is subdivided into three categories: nodular, massive, and infiltrative. Infiltrative HCC accounts for 7%-20% of HCC cases and is confirmed at pathologic analysis on the basis of the spread of minute tumor nodules throughout large regions of the liver. Infiltrative HCC may represent a diagnostic challenge because it is often difficult to distinguish from background changes in cirrhosis at imaging. Infiltrative HCC usually spreads over multiple hepatic segments, occupying an entire hepatic lobe or the entire liver, and it is frequently associated with portal vein tumor thrombosis. The tumor is usually ill defined at ultrasonography and shows minimal and inconsistent arterial enhancement and heterogeneous washout at contrast material-enhanced computed tomography and magnetic resonance (MR) imaging. The tumor may be more visible among the surrounding liver parenchyma at diffusion-, T1-, and T2-weighted MR imaging. Several liver diseases can mimic the infiltrative appearance of this malignancy, including focal confluent fibrosis, hepatic fat deposition, hepatic microabscesses, intrahepatic cholangiocarcinoma, and diffuse metastatic disease (pseudocirrhosis). The prognosis for patients with infiltrative HCC is poor because the tumor is often markedly advanced and associated with vascular invasion at presentation. Survival after surgical resection is decreased; thus, infiltrative HCC is a contraindication for resection and transplantation. Knowledge of the key tumor characteristics and imaging findings will help radiologists formulate a correct and timely diagnosis to improve patient management. (C) RSNA, 2015