Skip to main content

Table 3 Summary of diagnostic imaging findings [14, 16, 2229, 31]

From: Contemporary management of fibrolamellar hepatocellular carcinoma: diagnosis, treatment, outcome, prognostic factors, and recent developments

Diagnostic imaging Finding FL-HCC Finding HCC in cirrhosis Comments
US - Well-defined mass of variable echogenicity
- Partially successful in demonstrating central scares as a central area of hyperechogenicity
- Demonstrates calcification within the fibrous scar
- Lesions may appear hyperechoic, hypoechoic, or as target lesions, none of which is specific - In general, nonspecific sonographic features
- Less useful for demonstrating necrosis
- Less accurate than CT and MRI in demonstrating regional lymphadenopathy
- The optimal tool for screening HCC in cirrhosis
CT - Large tumor with well-defined margins
- Lobulated or smooth surface
- Calcification and a central scare
- Areas of hypervascularity
- Abnormal lymphadenopathy
- Portal vein thrombosis and biliary obstruction are extremely rare
- Generally tumors show a heterogeneous hypervascular enhancement
- Necrosis, hemorrhage, focal tumor fat, and invasion of vascular structures are common
- Hypoattenuating to surrounding liver
- Central scare, fibrosis, and calcification are rare
- Arterial hypervascularity (elevated arterial flow), venous phase washout (reduced or absent portal venous flow)
- Presence of fat
- In some cases of FL-HCC margins can be ill defined.
- CT demonstrates calcification in FL-HCC better than MRI.
- In CT a central scare is not pathognomonic of FL-HCC
MRI - Large tumor, hypointense on T1-weighted images and hyperintense on T2-weighted images
- No calcification but a central scare
- No fat component
- Generally tumors show a heterogeneous hypervascular enhancement; hyperattenuating on the arterial phase, hypo-, iso-, or even hyperattenuating in venous phases
- Well-circumscribed borders
- Low signal intensity on T1-weighted images and high signal intensity on T2-weighted images
- Intratumoral fat
- Tumor encapsulation
- Portal or hepatic vein invasion
- Arterial-portal venous shanting
- Generally, variable in appearance depending on steatosis or hemorrhage
- MRI is considered to be competitive rather than complimentary to CT in most cases.
- MRI demonstrates the central scare in FL-HCC better than CT
- MRI is may be more sensitive in detecting small lesions
  1. FL-HCC fibrolamellar hepatocellular carcinoma, HCC, usual hepatocellular carcinoma, US ultrasound, CT computed tomography, MRI magnetic resonance imaging