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Hepatocellular Carcinoma in Patients with Nonalcoholic Fatty Liver Disease: Helical CT and MR Imaging Findings with Clinical-Pathologic Comparison¹

¹ From the Departments of Radiology (R.I., F.P., V.V.), Pathology (V.P.), Surgery (J.B.), and Hepatology (F.D.), Hôpital Beaujon, Clichy, France; Department of Radiology, Università Cattolica del Sacro Cuore, Policlinico A. Gemelli, Rome, Italy (F.P.); Department of Radiological Sciences, University of Rome-La Sapienza, Policlinico Umberto I, Rome, Italy (R.I., R.P.); and Departments of Radiology (T.M., M.H., T.K., H.N.), Pathology (K.W.), and Surgery (M.M.), Osaka University Graduate School of Medicine, Osaka, Japan. Received July 25, 2005; revision requested September 28; final revision received June 16, 2006; final version accepted September 12. Address correspondence to R.I., Via Arturo Graf, 40, 00137 Rome, Italy (e-mail: r_iannaccone{at}yahoo.it).

View larger version (154K): [in this window] [in a new window] [Download PPT slide]   Figure 1a: Transverse CT scans show solitary HCC in a 55-year-old overweight man with type 2 diabetes and abdominal pain. (a) Unenhanced scan shows large mass (arrows) in right lobe of the liver. The mass is faintly hyperattenuating to liver due to foci of hemorrhage. A central hypoattenuating necrotic area (arrowhead) is seen in the mass. (b) Contrast-enhanced scan obtained during hepatic arterial phase demonstrates heterogeneous enhancement of the tumor (arrows), with a central necrotic area. (c) Contrast-enhanced scan obtained during portal venous phase shows that the tumor (arrows) has persistent heterogeneous hyperattenuation compared with adjacent liver parenchyma.

View larger version (153K): [in this window] [in a new window] [Download PPT slide]   Figure 1b: Transverse CT scans show solitary HCC in a 55-year-old overweight man with type 2 diabetes and abdominal pain. (a) Unenhanced scan shows large mass (arrows) in right lobe of the liver. The mass is faintly hyperattenuating to liver due to foci of hemorrhage. A central hypoattenuating necrotic area (arrowhead) is seen in the mass. (b) Contrast-enhanced scan obtained during hepatic arterial phase demonstrates heterogeneous enhancement of the tumor (arrows), with a central necrotic area. (c) Contrast-enhanced scan obtained during portal venous phase shows that the tumor (arrows) has persistent heterogeneous hyperattenuation compared with adjacent liver parenchyma.

View larger version (152K): [in this window] [in a new window] [Download PPT slide]   Figure 1c: Transverse CT scans show solitary HCC in a 55-year-old overweight man with type 2 diabetes and abdominal pain. (a) Unenhanced scan shows large mass (arrows) in right lobe of the liver. The mass is faintly hyperattenuating to liver due to foci of hemorrhage. A central hypoattenuating necrotic area (arrowhead) is seen in the mass. (b) Contrast-enhanced scan obtained during hepatic arterial phase demonstrates heterogeneous enhancement of the tumor (arrows), with a central necrotic area. (c) Contrast-enhanced scan obtained during portal venous phase shows that the tumor (arrows) has persistent heterogeneous hyperattenuation compared with adjacent liver parenchyma.

View larger version (154K): [in this window] [in a new window] [Download PPT slide]   Figure 2a: Transverse MR images show solitary HCC in 44-year-old obese man with type 2 diabetes and abnormal liver function test results. (a) T2-weighted turbo spin-echo image (repetition time msec/echo time msec, 3250/110) shows a large mass (arrows) with well-defined margins and a regular surface in the left lobe. The mass is heterogeneously hyperintense to liver. (b) Unenhanced fat-saturated T1-weighted image (160/4.9, 80° flip angle) shows that the tumor (arrows) is mildly hypointense to the adjacent liver. (c) Contrast-enhanced fat-saturated T1-weighted image (160/4.9, 80° flip angle) obtained during hepatic arterial phase demonstrates heterogeneous enhancement of the tumor (arrows). (d) Image obtained during portal venous phase shows that the tumor (arrows) is mildly hyperintense to adjacent liver parenchyma, with small areas of hypointensity.

View larger version (145K): [in this window] [in a new window] [Download PPT slide]   Figure 2b: Transverse MR images show solitary HCC in 44-year-old obese man with type 2 diabetes and abnormal liver function test results. (a) T2-weighted turbo spin-echo image (repetition time msec/echo time msec, 3250/110) shows a large mass (arrows) with well-defined margins and a regular surface in the left lobe. The mass is heterogeneously hyperintense to liver. (b) Unenhanced fat-saturated T1-weighted image (160/4.9, 80° flip angle) shows that the tumor (arrows) is mildly hypointense to the adjacent liver. (c) Contrast-enhanced fat-saturated T1-weighted image (160/4.9, 80° flip angle) obtained during hepatic arterial phase demonstrates heterogeneous enhancement of the tumor (arrows). (d) Image obtained during portal venous phase shows that the tumor (arrows) is mildly hyperintense to adjacent liver parenchyma, with small areas of hypointensity.

View larger version (159K): [in this window] [in a new window] [Download PPT slide]   Figure 2c: Transverse MR images show solitary HCC in 44-year-old obese man with type 2 diabetes and abnormal liver function test results. (a) T2-weighted turbo spin-echo image (repetition time msec/echo time msec, 3250/110) shows a large mass (arrows) with well-defined margins and a regular surface in the left lobe. The mass is heterogeneously hyperintense to liver. (b) Unenhanced fat-saturated T1-weighted image (160/4.9, 80° flip angle) shows that the tumor (arrows) is mildly hypointense to the adjacent liver. (c) Contrast-enhanced fat-saturated T1-weighted image (160/4.9, 80° flip angle) obtained during hepatic arterial phase demonstrates heterogeneous enhancement of the tumor (arrows). (d) Image obtained during portal venous phase shows that the tumor (arrows) is mildly hyperintense to adjacent liver parenchyma, with small areas of hypointensity.

View larger version (158K): [in this window] [in a new window] [Download PPT slide]   Figure 2d: Transverse MR images show solitary HCC in 44-year-old obese man with type 2 diabetes and abnormal liver function test results. (a) T2-weighted turbo spin-echo image (repetition time msec/echo time msec, 3250/110) shows a large mass (arrows) with well-defined margins and a regular surface in the left lobe. The mass is heterogeneously hyperintense to liver. (b) Unenhanced fat-saturated T1-weighted image (160/4.9, 80° flip angle) shows that the tumor (arrows) is mildly hypointense to the adjacent liver. (c) Contrast-enhanced fat-saturated T1-weighted image (160/4.9, 80° flip angle) obtained during hepatic arterial phase demonstrates heterogeneous enhancement of the tumor (arrows). (d) Image obtained during portal venous phase shows that the tumor (arrows) is mildly hyperintense to adjacent liver parenchyma, with small areas of hypointensity.

View larger version (164K): [in this window] [in a new window] [Download PPT slide]   Figure 3a: Transverse MR images show solitary HCC in 71-year-old obese man with type 2 diabetes. (a) T2-weighted turbo spin-echo image (3250/110) shows a mass (arrow) with well-defined margins and a regular surface in the right posterior segment. The mass is hyperintense to liver. Note the compression of the right hepatic vein (arrowhead). (b) Unenhanced T1-weighted gradient-recalled-echo out-of-phase image (145/1.8, 80° flip angle) shows that the tumor (arrow) is isointense to adjacent liver. (c) Contrast-enhanced fat-saturated T1-weighted image (160/4.9, 80° flip angle) obtained during hepatic arterial phase demonstrates heterogeneous enhancement of the tumor (arrow). (d) Image obtained during portal venous phase shows that the tumor (white arrow) demonstrates persistent hyperintensity compared with adjacent liver parenchyma. Note also the perfusion abnormality (black arrow) at the periphery of the tumor. (e) Image obtained during delayed phase shows that the tumor (arrow) becomes isointense to adjacent liver parenchyma. Note the hyperintense rim, which corresponds to the tumoral capsule.

View larger version (160K): [in this window] [in a new window] [Download PPT slide]   Figure 3b: Transverse MR images show solitary HCC in 71-year-old obese man with type 2 diabetes. (a) T2-weighted turbo spin-echo image (3250/110) shows a mass (arrow) with well-defined margins and a regular surface in the right posterior segment. The mass is hyperintense to liver. Note the compression of the right hepatic vein (arrowhead). (b) Unenhanced T1-weighted gradient-recalled-echo out-of-phase image (145/1.8, 80° flip angle) shows that the tumor (arrow) is isointense to adjacent liver. (c) Contrast-enhanced fat-saturated T1-weighted image (160/4.9, 80° flip angle) obtained during hepatic arterial phase demonstrates heterogeneous enhancement of the tumor (arrow). (d) Image obtained during portal venous phase shows that the tumor (white arrow) demonstrates persistent hyperintensity compared with adjacent liver parenchyma. Note also the perfusion abnormality (black arrow) at the periphery of the tumor. (e) Image obtained during delayed phase shows that the tumor (arrow) becomes isointense to adjacent liver parenchyma. Note the hyperintense rim, which corresponds to the tumoral capsule.

View larger version (147K): [in this window] [in a new window] [Download PPT slide]   Figure 3c: Transverse MR images show solitary HCC in 71-year-old obese man with type 2 diabetes. (a) T2-weighted turbo spin-echo image (3250/110) shows a mass (arrow) with well-defined margins and a regular surface in the right posterior segment. The mass is hyperintense to liver. Note the compression of the right hepatic vein (arrowhead). (b) Unenhanced T1-weighted gradient-recalled-echo out-of-phase image (145/1.8, 80° flip angle) shows that the tumor (arrow) is isointense to adjacent liver. (c) Contrast-enhanced fat-saturated T1-weighted image (160/4.9, 80° flip angle) obtained during hepatic arterial phase demonstrates heterogeneous enhancement of the tumor (arrow). (d) Image obtained during portal venous phase shows that the tumor (white arrow) demonstrates persistent hyperintensity compared with adjacent liver parenchyma. Note also the perfusion abnormality (black arrow) at the periphery of the tumor. (e) Image obtained during delayed phase shows that the tumor (arrow) becomes isointense to adjacent liver parenchyma. Note the hyperintense rim, which corresponds to the tumoral capsule.

View larger version (157K): [in this window] [in a new window] [Download PPT slide]   Figure 3d: Transverse MR images show solitary HCC in 71-year-old obese man with type 2 diabetes. (a) T2-weighted turbo spin-echo image (3250/110) shows a mass (arrow) with well-defined margins and a regular surface in the right posterior segment. The mass is hyperintense to liver. Note the compression of the right hepatic vein (arrowhead). (b) Unenhanced T1-weighted gradient-recalled-echo out-of-phase image (145/1.8, 80° flip angle) shows that the tumor (arrow) is isointense to adjacent liver. (c) Contrast-enhanced fat-saturated T1-weighted image (160/4.9, 80° flip angle) obtained during hepatic arterial phase demonstrates heterogeneous enhancement of the tumor (arrow). (d) Image obtained during portal venous phase shows that the tumor (white arrow) demonstrates persistent hyperintensity compared with adjacent liver parenchyma. Note also the perfusion abnormality (black arrow) at the periphery of the tumor. (e) Image obtained during delayed phase shows that the tumor (arrow) becomes isointense to adjacent liver parenchyma. Note the hyperintense rim, which corresponds to the tumoral capsule.

View larger version (159K): [in this window] [in a new window] [Download PPT slide]   Figure 3e: Transverse MR images show solitary HCC in 71-year-old obese man with type 2 diabetes. (a) T2-weighted turbo spin-echo image (3250/110) shows a mass (arrow) with well-defined margins and a regular surface in the right posterior segment. The mass is hyperintense to liver. Note the compression of the right hepatic vein (arrowhead). (b) Unenhanced T1-weighted gradient-recalled-echo out-of-phase image (145/1.8, 80° flip angle) shows that the tumor (arrow) is isointense to adjacent liver. (c) Contrast-enhanced fat-saturated T1-weighted image (160/4.9, 80° flip angle) obtained during hepatic arterial phase demonstrates heterogeneous enhancement of the tumor (arrow). (d) Image obtained during portal venous phase shows that the tumor (white arrow) demonstrates persistent hyperintensity compared with adjacent liver parenchyma. Note also the perfusion abnormality (black arrow) at the periphery of the tumor. (e) Image obtained during delayed phase shows that the tumor (arrow) becomes isointense to adjacent liver parenchyma. Note the hyperintense rim, which corresponds to the tumoral capsule.