Hepatocellular Carcinoma

Preliminary Diagnosis: Hepatocellular Carcinoma

I. What imaging technique is first-line for this diagnosis?

Triple phase CT of the liver

II. Describe the advantages and disadvantages of this technique for diagnosis of hepatocellular carcinoma.

Advantages

• Gold standard in liver imaging

• Adequately able to detect and differentiate all hepatic lesions

• May help direct biopsy and treatment

• Better able to characterize the primary process and detect any secondary complications than other imaging modalities

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• Highly sensitive and specific in detecting and characterizing liver lesions

• Offers exquisite visualization of the surrounding soft tissues and osseous structures

Disadvantages

• Exposes patients to ionizing radiation

• Less portable than ultrasound imaging

III. What are the contraindications for the first-line imaging technique?

• Relative contraindication in pregnant women

IV. What alternative imaging techniques are available?

• Ultrasound of the liver

• Contrasted MR of the liver and abdomen

V. Describe the advantages and disadvantages of the alternative techniques for diagnosis of hepatocellular carcinoma.

Ultrasound of the liver

Advantages

• Highly portable imaging modality

• Does not expose patients to ionizing radiation

• Highly adept in detailing the vascularity of a liver lesion

• May be helpful in guiding percutaneous biopsy of a liver lesion

Disadvantages

• Has limited sensitivity and specificity in evaluating liver lesions

Contrasted MR of the liver and abdomen

Advantages

• Does not expose patients to ionizing radiation

• Highly adept in detecting and differentiating liver lesions

Disadvantages

• Expensive

• Long image acquisition time and exposes patients to ionizing motion artifact and susceptibility weighted artifact

• Less adept evaluation of the surrounding osseous structures than other imaging modalities

• Less adept in guiding percutaneous treatment than other imaging modalities

VI. What are the contraindications for the alternative imaging techniques?

Ultrasound of the liver

• No specific contraindications to sonographic imaging exist.

Contrasted MR of the liver and abdomen

• Contraindicated in patients with non-MR compatible hardware

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