Hepatocellular Carcinoma with Inferior vena cava invasion

HCC is a malignant tumor of hepatocellular origin that develops in patients with risk factors such as alcohol abuse, viral hepatitis, and metabolic liver disease. It can also occur, rarely, in patients with normal liver parenchyma. Grossly, HCC can undergo hemorrhage and necrosis because of a lack of fibrous stroma. Vascular invasion, particularly of the portal system, is common. This is a known case of HCC with raised alphfetoprotein with MRI showing inferior vena cava and right atrial thrombus.

Dr.Sumer K Sethi, MD

Consultant Radiologist ,VIMHANS and CEO-Teleradiology Providers

Editor-in-chief, The Internet Journal of Radiology

Director, DAMS (Delhi Academy of Medical Sciences

Hepatocellular Carcinoma-MRI Findings

Notes for residents---A patient of alcoholic disease with raised alfa foetoprotein (can be more than 1000 ng/ml in 50% cases) and FNAC postive HCC. Features include capsule formation, presence of fat, suppressed on out of phase GRE images, no definite portal venous or hepatic venous invasion, No MR demonstrable calcification or biliary dilatation.Color doppler showed plenty of vascularity with increased diastolic flow.More common in males (7 to 8 times) more in 30-60 yrs. Contrast study would show increased early arterial enhancement, No significant contrast on equilibrium stage or hepatobiliary phase (1 hour) because hepatocytes are unable to excrete gadolinium in to bile and show it. Another feature would be peripheral washout in portal venous pahse. Pseudocapsule can enhance in portal venous phase. Case submitted by Dr MGK Murthy Sr Consultant Teleradiology Providers