Download Document

Salzburg Weill Cornell Seminar in Diagnostic Imaging
Hepatic tumors
Siarhei Kharuzhyk, M.D., Ph.D.
N.N. Alexandrov National Cancer Center,
Minsk Region, Belarus
9 – 15 October 2011, Salzburg, Austria
Patient history
Male, 57 y. o.
Liver hemangioma on US for 8 y.
Pain in the abdomen for 1 month
Diagnostic procedures
Laboratory tests:
Erythrocyte sedimentation rate – 21 mm/hr
(upper normal value 15 mm/hr)
The rest of blood tests were normal
Patient was sent to abdominal CT/MRI
Native phase CT
Tumor in liver
segments 1-4
(density 43 HU)
on the
background of
steatosis
Late arterial phase
Tumor density
60 HU max.
Portal venous phase
97 HU max.
Delayed phase 10 min
84 HU max.
Do you see
something else???
MRI T2w
Two hyperintense tumors, the larger one is
heterogeneous
MRI T1w CE
Delayed enhancement in both tumors
Native
25 sec.
3 min.
6 min.
12 min.
25 min.
MRI T1w CE at the lower level
Native
25 sec.
3 min.
6 min.
12 min.
25 min.
Larger tumor enhance heterogeneously, no contrast
wash-out at 25 min
What is yours
conclusion?
Correct diagnosis
Hemangioma in the right liver lobe (segments 7-8)
Cholangiocarcinoma in the left liver lobe (segments
1-4)
Hints to diagnosis
Hemangioma:
Mostly homogeneous high signal on T2w
Lacunar enhancement
Progressive filling from periphery to center
Complete contrast filling in delayed phases
Hints to diagnosis
СhС:
Heterogeneously high signal on T2w
Heterogeneous rimlike or bandlike CE
Concentric but incomplete contrast filling
(fibrotic component!)
“Lacunar-like” enhancement!
Hints to diagnosis
СhС:
Dilated bile ducts (!!!)
Enlarged lymph node (metastasis)
Outcome
Patient underwent left hemihepatectomy with
portal hepatic lymph nodes metastases excision
Unfortunately, liver and brain metastases
developed 4 months after operation
Thank you for attention!