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Fibrolamellar Hepatocellular Carcinoma: Imaging and Pathologic Findings in 31 Recent Cases¹

¹ From the Departments of Radiology (T.I., M.P.F., L.G.), Surgery (J.M., W.M.), and Pathology (M.N.), University of Pittsburgh Medical Center, 200 Lothrop St, Pittsburgh, PA 15213. Received December 30, 1998; revision requested February 8, 1999; revision received March 16; accepted June 9. Address reprint requests to M.P.F. (e-mail: federlemp@radserv.arad.upmc .edu).

PURPOSE: To review characteristic findings of fibrolamellar hepatocellular carcinoma (HCC) at computed tomography (CT) and magnetic resonance (MR) imaging.

MATERIALS AND METHODS: The authors retrospectively reviewed the clinical, pathologic, and preoperative imaging findings in 31 patients with histologically proved fibrolamellar HCC. Dynamic contrast material–enhanced CT of the liver was performed in 31 patients, helical multiphase CT in 21, and MR imaging in 11. Complete resection was performed in 17 patients, and imaging-pathologic correlation was performed.

RESULTS: Large tumors (mean diameter, 13 cm) were depicted at CT and MR in all cases. At CT, the margins of the tumors were well defined in 24 (77%) of 31 cases, calcifications were depicted in 21 (68%), a central scar in 22 (71%), and abdominal lymphadenopathy in 20 (65%). In 20 (80%) of 25 cases with hepatic arterial phase CT images, all tumors were heterogeneous and depicted areas of hypervascularity. At MR imaging, tumors were hypointense to liver on TI-weighted images (n = 11) and hyperintense to liver on T2-weighted images (n = 10). Calcification was not depicted on MR images, but a central scar was depicted as hypointense to surrounding tumor in nine cases.

CONCLUSION: CT and MR images demonstrate characteristic features that may allow confident diagnosis of fibrolamellar HCC.

Index terms: Liver neoplasms, CT, 761.12111, 761.12112, 761.12113, 761.12114, 761.12115 • Liver neoplasms, diagnosis, 761.324 • Liver neoplasms, MR, 761.121411, 761.121412, 761.12143 • Magnetic resonance (MR), contrast agents, 761.12143

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