LI Wentao 1 , SONG Bin 1 , WU Bi 1 , CHEN Weixia 1 , XU Jun. 2
  • Department of Radiology, West China Hospital，Sichuan University, Chengdu 610041, China;
Primary hepatocellular carcinoma Venous vessel Bile duct Tomography/X-ray computed
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【Abstract】Objective  To investigate the imaging features of malignant invasion of major intrahepatic ductal structures (the portal and hepatic venous vasculature, the bilie duct) by primary hepatocellular carcinoma (HCC) using multidetector-row spiral CT (MDCT).
Methods  We retrospectively analyzed 68 documented HCC patients with tumorous invasion of the major intrahepatic ductal structures who had undergone contrast-enhanced dual-phase MDCT scanning of the upper abdomen.The morphological changes of the portal and hepatic venous vasculature, the bile duct, and the liver parenchyma at both the hepatic arterial phase and portal venous phase images were carefully observed and recorded.
Results  Among the 68 patients, 47 patients had malignant invasion of the intrahepatic portal venous vessels with secondary tumor thrombus formation; 12 patients had tumor involvement of the hepatic veins and intraheptic segment of the inferior vena cava; Tumor invasion of the bile duct was seen in 9 patents. The direct CT signs of tumor invasion of intrahepatic venous vessels included: ①dilatation or enlargement of the involved vein with intraluminal softtissue “filling defect”； ②enhancement of the tumor thrombus at hepatic arterial phase, the so-called “venous arterialization” phenomenon. The indirect CT signs included: ①arterial-venous shunt, ②early and heterogeneous enhancement of the hepatic parenchyma adjacent to HCC focus, ③cavernous transformation of the portal vein. The CT signs suggesting tumor invasion of the bile duct included: ①dilation of the bile ducts near or proximal to HCC lesion, ②soft-tissue nodule or mass inside the bile ducts.
Conclusion  Invasion of major intrahepatic ductal structures by HCC will present corresponding CT imaging features. Contrast-enhanced MDCT dualphase scanning combined with appropriate image postprocessing techniques can better evaluate the malignant invasion of major intrahepatic ductal structures.

Citation： LI Wentao,SONG Bin,WU Bi,CHEN Weixia,XU Jun.. Invasion of Major Intrahepatic Ductal Structures by Hepatocellular Carcinoma: Multi-Detector-Row Spiral CT Manifestations. CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY, 2004, 11(6): 542-546. doi: Copy