Hepatocellular carcinoma CT

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] Associate Editor(s)-in-Chief: Dildar Hussain, MBBS [2]

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Abdominal CT scan with intravenous contrast agent is used to diagnose hepatocellular carcinoma. Three-phase scanning (before contrast administration, immediately after contrast administration, and again after a delay) is employed to increase the ability of the radiologist to detect small tumors. It is important to optimize the parameters of the CT examination, because the underlying liver disease (e.g. hepatitis B) that most hepatocellular carcinoma patients have can make the findings more difficult to appreciate.

CT scan

  • Abdominal CT scan may be helpful in the diagnosis of hepatocellular carcinoma (HCC).
  • Findings on CT scan suggestive of hepatocellular carcinoma include the following:[1][2][3][4]
    • Enhanced mass during the arterial phase
    • Wedge shaped perfusion abnormality because of the arterioportal shunts (APS)
    • Focal fatty change in the normal liver
    • Focal fatty sparing in the diffusely fatty liver
    • Halo of focal fatty sparing around the hepatocellular carcinoma
Type Appearance
Massive HCC
  • Large hypoattenuating mass
  • May have necrosis/fat/calcification
Nodular HCC
  • Multiple masses of different attenuation are observed
  • Central necrosis may be observed
Infiltrative HCC
  • May be difficult to distinguish from associated cirrhosis


  1. Kim KW, Kim MJ, Lee SS, Kim HJ, Shin YM, Kim PN, Lee MG (2008). "Sparing of fatty infiltration around focal hepatic lesions in patients with hepatic steatosis: sonographic appearance with CT and MRI correlation". AJR Am J Roentgenol. 190 (4): 1018–27. doi:10.2214/AJR.07.2863. PMID 18356450.
  2. Reynolds AR, Furlan A, Fetzer DT, Sasatomi E, Borhani AA, Heller MT, Tublin ME (2015). "Infiltrative hepatocellular carcinoma: what radiologists need to know". Radiographics. 35 (2): 371–86. doi:10.1148/rg.352140114. PMID 25763723.
  3. Gao HQ, Hu CH, Yu YX, Hu S, Shi C, Wang XM, Guo L (2016). "[Value of spectral CT-based quantitative analysis in differential diagnosis of liver cancer and liver abscess]". Zhonghua Gan Zang Bing Za Zhi (in Chinese). 24 (9): 676–680. PMID 27788724.
  4. Terzi, Eleonora; Salvatore, Veronica; Negrini, Giulia; Piscaglia, Fabio (2015). "Ongoing challenges in the diagnosis of hepatocellular carcinoma". Expert Review of Gastroenterology & Hepatology. 10 (4): 451–463. doi:10.1586/17474124.2016.1124758. ISSN 1747-4124.
  5. "Hepatocellular carcinoma | Radiology Case | Radiopaedia.org".
  6. "Diffuse hepatocellular cancer with malignant portal vein thrombosis | Radiology Case | Radiopaedia.org".

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