Salzburg Weill Cornell Seminar in Diagnostic ImagingSalzburg Weill Cornell Seminar in Diagnostic Imaging

Hepatic tumorsHepatic tumors

9 – 15 October 2011, Salzburg, Austria9 – 15 October 2011, Salzburg, Austria

Siarhei Kharuzhyk, M.D., Siarhei Kharuzhyk, M.D., Ph.D.Ph.D.

N.N. Alexandrov National Cancer N.N. Alexandrov National Cancer Center, Center,

Minsk Region, BelarusMinsk Region, Belarus

Male, 57 y. o. Male, 57 y. o.

Liver hemangioma on US for 8 y.Liver hemangioma on US for 8 y.

Pain in the abdomen for 1 monthPain in the abdomen for 1 month

Patient historyPatient history

Laboratory tests:Laboratory tests:Erythrocyte sedimentation rate – Erythrocyte sedimentation rate – 21 21 mm/hr mm/hr (upper normal value 15 mm/hr)(upper normal value 15 mm/hr)The rest of blood tests were normalThe rest of blood tests were normal

Patient was sent to Patient was sent to abdominal CT/MRIabdominal CT/MRI

Diagnostic proceduresDiagnostic procedures

Native phase Native phase CTCT

Tumor in liver Tumor in liver segments 1-4 segments 1-4 (density 43 (density 43 HU) on the HU) on the background of background of steatosis steatosis

Late arterial phaseLate arterial phaseTumor density Tumor density 60 HU max. 60 HU max.

Portal venous Portal venous phasephase97 HU max. 97 HU max.

Delayed phase 10 Delayed phase 10 minmin84 HU max.84 HU max.

Do you see Do you see something something else???else???

MRI T2wMRI T2wTwo hyperintense tumors,Two hyperintense tumors, the larger the larger one is heterogeneousone is heterogeneous

MRI T1w CEMRI T1w CEDelayed enhancement Delayed enhancement in both tumorsin both tumors

NativeNative 25 sec.25 sec. 3 min.3 min.

6 min.6 min. 12 min.12 min. 25 min.25 min.

MRI T1w CE MRI T1w CE at the lower levelat the lower level

NativeNative 25 sec.25 sec. 3 min.3 min.

6 min.6 min. 12 min.12 min. 25 min.25 min.

Larger tumor enhance heterogeneously, Larger tumor enhance heterogeneously, no no contrast wash-out at 25 mincontrast wash-out at 25 min

What is yours What is yours conclusion?conclusion?

HemangiomaHemangioma in the right liver lobe (segments in the right liver lobe (segments 7-8)7-8)

CholangiocarcinomaCholangiocarcinoma in the left liver lobe in the left liver lobe (segments 1-4)(segments 1-4)

Correct diagnosisCorrect diagnosis

Hemangioma:Hemangioma:Mostly homogeneous high signal on T2wMostly homogeneous high signal on T2wLacunar enhancementLacunar enhancementProgressive filling from periphery to Progressive filling from periphery to centercenterComplete contrast filling in delayed Complete contrast filling in delayed phasesphases

Hints to diagnosisHints to diagnosis

ССhhСС::Heterogeneously high signal on T2wHeterogeneously high signal on T2wHeterogeneous rimlike or bandlike CEHeterogeneous rimlike or bandlike CEConcentric but incomplete contrast filling Concentric but incomplete contrast filling (fibrotic component!)(fibrotic component!)

Hints to diagnosisHints to diagnosis

““Lacunar-like” enhancement!Lacunar-like” enhancement!

ССhhСС::Dilated bile ducts (!!!)Dilated bile ducts (!!!)Enlarged lymph node (metastasis)Enlarged lymph node (metastasis)

Hints to diagnosisHints to diagnosis

Patient underwent left hemihepatectomy Patient underwent left hemihepatectomy with portal hepatic lymph nodes with portal hepatic lymph nodes metastases excisionmetastases excision

Unfortunately, liver and brain metastases Unfortunately, liver and brain metastases developed 4 months after operationdeveloped 4 months after operation

OutcomeOutcome

Thank you for Thank you for attention!attention!