대한영상의학회지 (Journal of the Korean Society of Radiology)

  • 제83권4호
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  • Pages.808-829
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  • 2022
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  • 1738-2637(pISSN)
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  • 2288-2928(eISSN)
대한영상의학회 (The Korean Society of Radiology)
권호 표지
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원발성 간세포암의 비특이적 영상 소견 및 간암으로 오인될 수 있는 병변에 대한 영상의학적 고찰

Atypical Manifestation of Primary Hepatocellular Carcinoma and Hepatic Malignancy Mimicking Lesions

  • 윤지영 (가천대학교 의과대학 길병원 영상의학과) ;
  • 박소현 (가천대학교 의과대학 길병원 영상의학과) ;
  • 안수좌 (가천대학교 의과대학 길병원 영상의학과) ;
  • 심영섭 (가천대학교 의과대학 길병원 영상의학과)
  • Jiyoung Yoon (Department of Radiology, Gil Medical Center, Gachon University College of Medicine) ;
  • So Hyun Park (Department of Radiology, Gil Medical Center, Gachon University College of Medicine) ;
  • Su Joa Ahn (Department of Radiology, Gil Medical Center, Gachon University College of Medicine) ;
  • Young Sup Shim (Department of Radiology, Gil Medical Center, Gachon University College of Medicine)
  • 투고 : 2021.11.15
  • 심사 : 2022.01.27
  • 발행 : 2022.07.01
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초록

간세포암종은 역동적 조영증강 컴퓨터단층촬영이나 자기공명영상에서의 동맥기 조영증강 및 문맥기 또는 지연기 씻김현상과 같은 전형적 영상 소견을 기반으로 비침습적으로 진단할 수 있다. 그러나 일부 간세포암종은 비전형적인 영상 소견을 나타내기 때문에 영상의학과 의사는 진단에 있어 어려움에 직면하게 된다. 더욱이 동맥 문맥 단락, 혼합 간세포-담관암, 간내 담관암, 혈관종과 같이 많은 간세포암 유사 병변들이 다수 존재하여 영상을 통한 감별 진단에 난항을 겪는다. 초기 영상 검사에서 간세포암종과 이러한 유사 종양을 구별하는 능력은 적절한 관리 및 치료 결정에 중요하다. 따라서 본 임상화보에서는 간세포암종의 비전형적 영상 소견과 간세포암종을 모방하는 악성 및 양성 병변들의 영상 소견을 제시하고 감별 진단을 좁히는 데 도움이 될 수 있는 중요한 단서들에 대해 알아보고자 한다.

Hepatocellular carcinoma (HCC) can be diagnosed noninvasively on multiphasic CT and MRI based on its distinctive imaging findings. These features include arterial phase hyperenhancement and washout on portal or delayed phase images. However, radiologists face significant diagnostic challenges because some HCCs exhibit atypical imaging characteristics. In addition to many HCC-mimicking lesions, such as arterioportal shunts, combined HCC-cholangiocarcinoma, intrahepatic cholangiocarcinoma, and hemangioma present a challenge for radiologists in actual clinical practice. The ability to distinguish HCCs from mimickers on initial imaging examinations is crucial for appropriate management and treatment decisions. Therefore, this pictorial review presents the imaging findings of atypical HCCs and HCCs mimicking malignant and benign lesions and discusses important clues that may help narrow down the differential diagnosis.

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참고문헌

  1. European Association for the Study of the Liver. EASL clinical practice guidelines: management of hepatocellular carcinoma. J Hepatol 2018;69:182-236 
  2. Choi JY, Lee JM, Sirlin CB. CT and MR imaging diagnosis and staging of hepatocellular carcinoma: part I. Development, growth, and spread: key pathologic and imaging aspects. Radiology 2014;272:635-654 
  3. Yoon JH, Park JW, Lee JM. Noninvasive diagnosis of hepatocellular carcinoma: elaboration on Korean Liver Cancer Study Group-National Cancer Center Korea practice guidelines compared with other guidelines and remaining issues. Korean J Radiol 2016;17:7-24 
  4. Kim JH, Joo I, Lee JM. Atypical appearance of hepatocellular carcinoma and its mimickers: how to solve challenging cases using gadoxetic acid-enhanced liver magnetic resonance imaging. Korean J Radiol 2019;20:1019-1041 
  5. Chernyak V, Fowler KJ, Kamaya A, Kielar AZ, Elsayes KM, Bashir MR, et al. Liver imaging reporting and data system (LI-RADS) version 2018: imaging of hepatocellular carcinoma in at-risk patients. Radiology 2018;289:816-830 
  6. Cannella R, Fraum TJ, Ludwig DR, Borhani AA, Tsung A, Furlan A, et al. Targetoid appearance on T2-weighted imaging and signs of tumor vascular involvement: diagnostic value for differentiating HCC from other primary liver carcinomas. Eur Radiol 2021;31:6868-6878 
  7. Kim YY, Kim MJ, Kim EH, Roh YH, An C. Hepatocellular carcinoma versus other hepatic malignancy in cirrhosis: performance of LI-RADS version 2018. Radiology 2019;291:72-80 
  8. Asayama Y, Yoshimitsu K, Nishihara Y, Irie H, Aishima S, Taketomi A, et al. Arterial blood supply of hepatocellular carcinoma and histologic grading: radiologic-pathologic correlation. AJR Am J Roentgenol 2008;190:W28-W34 
  9. Gu KW, Kim YK, Min JH, Ha SY, Jeong WK. Imaging features of hepatic sarcomatous carcinoma on computed tomography and gadoxetic acid-enhanced magnetic resonance imaging. Abdom Radiol (NY) 2017;42:1424-1433 
  10. Park HJ, Kim YK, Cha DI, Ko SE, Kim S, Lee ES, et al. Targetoid hepatic observations on gadoxetic acid-enhanced MRI using LI-RADS version 2018: emphasis on hepatocellular carcinomas assigned to the LR-M category. Clin Radiol 2020;75:478.e13-478.e23 
  11. Park MJ, Kim YK, Park HJ, Hwang J, Lee WJ. Scirrhous hepatocellular carcinoma on gadoxetic acid-enhanced magnetic resonance imaging and diffusion-weighted imaging: emphasis on the differentiation of intrahepatic cholangiocarcinoma. J Comput Assist Tomogr 2013;37:872-881 
  12. Hwang SH, Yu JS, Kim KW, Kim JH, Chung JJ. Small hypervascular enhancing lesions on arterial phase images of multiphase dynamic computed tomography in cirrhotic liver: fate and implications. J Comput Assist Tomogr 2008;32:39-45 
  13. Byrnes V, Shi H, Kiryu S, Rofsky NM, Afdhal NH. The clinical outcome of small (<20 mm) arterially enhancing nodules on MRI in the cirrhotic liver. Am J Gastroenterol 2007;102:1654-1659 
  14. Choi BI, Lee KH, Han JK, Lee JM. Hepatic arterioportal shunts: dynamic CT and MR features. Korean J Radiol 2002;3:1-15 
  15. Motosugi U, Ichikawa T, Sou H, Sano K, Tominaga L, Muhi A, et al. Distinguishing hypervascular pseudolesions of the liver from hypervascular hepatocellular carcinomas with gadoxetic acid-enhanced MR imaging. Radiology 2010;256:151-158 
  16. Park SH, Kim B, Kim SY, Choi SJ, Huh J, Kim HJ, et al. Characterizing computed tomography-detected arterial hyperenhancing-only lesions in patients at risk of hepatocellular carcinoma: can non-contrast magnetic resonance imaging be used for sequential imaging? Korean J Radiol 2020;21:280-289 
  17. Lee JH, Lee JM, Kim SJ, Baek JH, Yun SH, Kim KW, et al. Enhancement patterns of hepatocellular carcinomas on multiphasicmultidetector row CT: comparison with pathological differentiation. Br J Radiol 2012;85:e573-e583 
  18. Okano H, Shiraki K, Inoue H, Ito T, Yamanaka T, Deguchi M, et al. Natural course of cavernous hepatic hemangioma. Oncol Rep 2001;8:411-414 
  19. Yeh WC, Yang PM, Huang GT, Sheu JC, Chen DS. Long-term follow-up of hepatic hemangiomas by ultrasonography: with emphasis on the growth rate of the tumor. Hepatogastroenterology 2007;54:475-479 
  20. Hasan HY, Hinshaw JL, Borman EJ, Gegios A, Leverson G, Winslow ER. Assessing normal growth of hepatic hemangiomas during long-term follow-up. JAMA Surg 2014;149:1266-1271 
  21. Liu Z, Yi L, Chen J, Li R, Liang K, Chen X, et al. Comparison of the clinical and MRI features of patients with hepatic hemangioma, epithelioid hemangioendothelioma, or angiosarcoma. BMC Med Imaging 2020;20:71 
  22. Horie Y, Katoh S, Yoshida H, Imaoka T, Suou T, Hirayama C. Pedunculated hepatocellular carcinoma. Report of three cases and review of literature. Cancer 1983;51:746-751 
  23. Kimura H, Inoue T, Konishi K, Tsuneda A, Tazawa K, Earashi M, et al. Hepatocellular carcinoma presenting as extrahepatic mass on computed tomography. J Gastroenterol 1997;32:260-263 
  24. Jung HI. Giant pedunculated hepatocellular carcinoma masquerading as a pelvic mass: a case report. Korean J Hepatobiliary Pancreat Surg 2014;18:56-59 
  25. Roumanis PS, Bhargava P, Kimia Aubin G, Choi JI, Demirjian AN, Thayer DA, et al. Atypical magnetic resonance imaging findings in hepatocellular carcinoma. Curr Probl Diagn Radiol 2015;44:237-245 
  26. Subasinghe D, Rathnasena BN, Medagodahetti US, Bhishman T. Gastrointestinal stromal tumour of the stomach mimicking a hepatic tumour: a case report. BMC Res Notes 2014;7:147 
  27. Kim HJ, Lee DH, Lim JW, Ko YT, Kim KW. Exophytic benign and malignant hepatic tumors: CT imaging features. Korean J Radiol 2008;9:67-75 
  28. Nishino M, Hayakawa K, Minami M, Yamamoto A, Ueda H, Takasu K. Primary retroperitoneal neoplasms: CT and MR imaging findings with anatomic and pathologic diagnostic clues. Radiographics 2003;23:45-57 
  29. European Association for the Study of the Liver. EASL clinical practice guidelines: management of hepatocellular carcinoma. J Hepatol 2018;69:182-236 
  30. Korean Liver Cancer Association (KLCA), National Cancer Center (NCC). 2018 Korean Liver Cancer Association-National Cancer Center Korea Practice Guidelines for the management of hepatocellular carcinoma. Korean J Radiol 2019;20:1042-1113 
  31. Yang JD, Hainaut P, Gores GJ, Amadou A, Plymoth A, Roberts LR. A global view of hepatocellular carcinoma: trends, risk, prevention and management. Nat Rev Gastroenterol Hepatol 2019;16:589-604 
  32. Dietrich CF, Sharma M, Gibson RN, Schreiber-Dietrich D, Jenssen C. Fortuitously discovered liver lesions. World J Gastroenterol 2013;19:3173-3188 
  33. Gore RM, Pickhardt PJ, Mortele KJ, Fishman EK, Horowitz JM, Fimmel CJ, et al. Management of incidental liver lesions on CT: a white paper of the ACR Incidental Findings Committee. J Am Coll Radiol 2017;14:1429-1437 
  34. Min JH, Kim YK, Choi SY, Kang TW, Lee SJ, Kim JM, et al. Intrahepatic mass-forming cholangiocarcinoma: arterial enhancement patterns at MRI and prognosis. Radiology 2019;290:691-699 
  35. Rimola J, Forner A, Reig M, Vilana R, de Lope CR, Ayuso C, et al. Cholangiocarcinoma in cirrhosis: absence of contrast washout in delayed phases by magnetic resonance imaging avoids misdiagnosis of hepatocellular carcinoma. Hepatology 2009;50:791-798 
  36. Choi SH, Lee SS, Park SH, Kim KM, Yu E, Park Y, et al. LI-RADS classification and prognosis of primary liver cancers at gadoxetic acid-enhanced MRI. Radiology 2019;290:388-397 
  37. Jeon SK, Joo I, Lee DH, Lee SM, Kang HJ, Lee KB, et al. Combined hepatocellular cholangiocarcinoma: LI-RADS v2017 categorisation for differential diagnosis and prognostication on gadoxetic acid-enhanced MR imaging. Eur Radiol 2019;29:373-382 
  38. Park SH, Lee SS, Yu E, Kang HJ, Park Y, Kim SY, et al. Combined hepatocellular-cholangiocarcinoma: gadoxetic acid-enhanced MRI findings correlated with pathologic features and prognosis. J Magn Reson Imaging 2017;46:267-280 
  39. Sica GT, Ji H, Ros PR. CT and MR imaging of hepatic metastases. AJR Am J Roentgenol 2000;174:691-698 
  40. Gore RM, Thakrar KH, Wenzke DR, Newmark GM, Mehta UK, Berlin JW. That liver lesion on MDCT in the oncology patient: is it important? Cancer Imaging 2012;12:373-384 
  41. Park YS, Lee CH, Kim JW, Shin S, Park CM. Differentiation of hepatocellular carcinoma from its various mimickers in liver magnetic resonance imaging: what are the tips when using hepatocyte-specific agents? World J Gastroenterol 2016;22:284-299 
  42. Yoneda N, Matsui O, Kitao A, Kozaka K, Kobayashi S, Sasaki M, et al. Benign hepatocellular nodules: hepatobiliary phase of gadoxetic acid-enhanced MR imaging based on molecular background. Radiographics 2016;36:2010-2027 
  43. Hussain SM, Terkivatan T, Zondervan PE, Lanjouw E, de Rave S, Ijzermans JN, et al. Focal nodular hyperplasia: findings at state-of-the-art MR imaging, US, CT, and pathologic analysis. Radiographics 2004;24:3- 17; discussion 18-19 
  44. Paul PG, Gulati G, Shintre H, Mannur S, Paul G, Mehta S. Extrauterine adenomyoma: a review of the literature. Eur J Obstet Gynecol Reprod Biol 2018;228:130-136 
  45. Won YJ, Woo JY, Byun J, Hong ME. Extrauterine adenomyoma of the liver mimicking a hepatic adenoma: a case report. J Korean Soc Radiol 2019;81:197-202 
  46. Li T, Klar MM, Alawad M, Abdul R, Zahiruddin A, Salifu MO, et al. Hepatic sclerosing hemangioma mimicking malignancy: a case and literature review. Am J Med Case Rep 2021;9:144-146 
  47. Doyle DJ, Khalili K, Guindi M, Atri M. Imaging features of sclerosed hemangioma. AJR Am J Roentgenol 2007;189:67-72 
  48. Lee SJ, Kim SY, Kim KW, Kim JH, Kim HJ, Lee MG, et al. Hepatic angiomyolipoma versus hepatocellular carcinoma in the noncirrhotic liver on gadoxetic acid-enhanced MRI: a diagnostic challenge. AJR Am J Roentgenol 2016;207:562-570 
  49. Kim R, Lee JM, Joo I, Lee DH, Woo S, Han JK, et al. Differentiation of lipid poor angiomyolipoma from hepatocellular carcinoma on gadoxetic acid-enhanced liver MR imaging. Abdom Imaging 2015;40:531-541