E1186. A Silent Killer: Hepatocellular Carcinoma in Non-Cirrhotic Liver
  1. Anabel Liyen Cartelle; Augusta University Medical Center; Medical College of Georgia
  2. Varsha Chiruvella; Augusta University Medical Center; Medical College of Georgia
  3. Brett Hausauer; Augusta University Department of Radiology; Augusta University Medical Center
  4. Amit Hudgi; Augusta University Department of Medicine; Augusta University Medical Center
  5. Pardeep Mittal; Augusta University Department of Radiology; Augusta University Medical Center
  6. Jayanth Keshavamurthy; Augusta University Department of Radiology; Augusta VA Medical Center
  7. Lakshmi Vemavarapu; Augusta University Department of Pathology; Augusta VA Medical Center
Hepatocellular carcinoma (HCC) accounts for 90% of all primary liver cancers in adults. Traditionally, HCC is diagnosed in patients with chronic liver disease, namely cirrhosis (CL); however, nearly 20% occur in non-cirrhotic liver (NCL) patients. NCL HCC is often diagnosed incidentally and at more advanced stages due to its largely asymptomatic early course. Unfortunately, although NCL HCC patients typically qualify for curative resections due their preserved hepatic function, overall mortality remains like that of CL HCC due to higher tumor burden at presentation. It is important for radiologists to be familiar with the unique clinicopathological features of NCL HCC in contrast to CL HCC and with the role of imaging when working up a patient for HCC in the setting of a non-cirrhotic liver.

Educational Goals / Teaching Points
After reviewing this presentation, participants will be able to recognize differences in risk factors for and clinicopathological features of non-cirrhotic liver (NCL) HCC in comparison to cirrhotic (CL) HCC. They will be aware of the appropriate methodology employed when using computed tomography (CT) and magnetic resonance imaging (MRI) to evaluate for HCC. Lastly, throughout the exhibit, we will discuss HCC look-alikes, and the role of imaging in determining the ultimate diagnosis, prognosis, and treatment for NCL HCC and how this compares to CL HCC.

Key Anatomic/Physiologic Issues and Imaging Findings/Techniques
In this exhibit, we will focus primarily on CT and MRI imaging findings, presenting several case examples of NCL HCC with radiological, clinical, laboratory, and histological correlations. We will discuss the pattern of arterial phase hyperenhancement followed by portal venous or delayed phase washout seen in multiphase CT or MRI studies of these lesions and how these diagnostic criteria apply to NCL HCC in comparison to CL HCC. We will also address conditions under which other look-alike hypervascular lesions can be suspected in the setting of non-cirrhotic liver.

Given the steady rise in mortality secondary to HCC in the US, there needs to be further study of the genetic, clinical, radiological, and pathological nature of NCL HCC. We hope that this exhibit familiarizes participants with NCL HCC in multiple domains and emphasizes the importance of using this data to develop risk stratification tools that correctly identify high-risk individuals in hopes of improving prognosis through earlier detection.