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E1201. Multimodality Imaging Approach in Identifying Invasive Hepatocellular Carcinoma
Authors
  1. Woongsoon Choi; University of Texas Medical Branch
  2. Mohamed Elshikh; University of Texas Medical Branch
  3. Brian Wong; University of Texas Medical Branch
  4. Peeyush Bhargava; University of Texas Medical Branch
Background
Hepatocellular carcinoma (HCC) is the third leading cause of cancer-related deaths world-wide. The curative measures include liver resection and orthotopic transplantation. However, the presence of the vascular or locoregional invasion at the time of treatment negatively impacts the prognosis and precludes the patient from receiving aggressive treatment options, which can be futile as the recurrence rate is high. At the same time, a false diagnosis of vascular tumor invasion is devastating as the patient may be falsely excluded from potentially life-saving measures. For example, if a bland thrombus is misdiagnosed as a tumor thrombus, the patient may be mistakenly excluded from liver transplant. Therefore, the accurate and timely detection of the tumor invasion is particularly crucial in management. In this educational exhibit, we will review multimodality approach of detecting various patterns of HCC invasion in a case-based approach.

Educational Goals / Teaching Points
At the end of this educational exhibit, the audience will understand the importance of recognizing HCC invasion, different patterns of the invasion using a multimodality approach, as well as potential pitfalls.

Key Anatomic/Physiologic Issues and Imaging Findings/Techniques
Portal vein is the most common structure invaded by HCC, reported up to 10-40% at the time of diagnosis. Multi-modality approach can be particularly useful in differentiating the bland versus tumor thrombus. HCC may invade hepatic vein or inferior vena cava with eventual extension into the right atrium or other systemic venous circulation. Biliary tree and gallbladder are rarely invaded by HCC. A tumefactive gallbladder sludge should not be mistaken as a tumor thrombus. HCC can also directly involve the hepatic capsule, causing tumoral seeding in the peritoneal cavity. Although extremely rare, there are several reported cases where HCC invades into the gastrointestinal tract and the right hemidiaphragm.

Conclusion
HCC has been known for its high propensity for locoregional invasive and metastatic potential in various forms as described above. Therefore, the radiologist must be familiar with different modes of HCC local spread to correctly identify once encountered.