Triphasic liver CT findings of hepatocellular carcinoma in comparison to histopathology in MTRH, Eldoret

Abstract

Background: Hepatocellular carcinoma (HCC) is a primary malignancy of the liver common with underlying chronic liver disease including cirrhosis. Incidence of HCC is highest in Asia and Africa, due to the endemic high prevalence of hepatitis B and C viruses. HCC is increasingly being recognized with the improvement of dynamic imaging such as CT scan. Triphasic liver CT scan is used for diagnosis in a nodule>1cm with arterial enhancement followed by washout and the 2005 diagnostic algorithm has been validated and accuracy demonstrated. All suspected HCC patients are however subjected to biopsy at Moi Teaching and Referral Hospital hence this study will try to establish the value of CT scan in making a diagnosis of HCC. Objective: To evaluate the use of Triphasic computed tomography findings of hepatocellular carcinoma in comparison to histopathology findings so as to determine if CT imaging findings alone can be used to diagnose HCC without performing a core biopsy. Methods: This was a descriptive cross-sectional study done at Moi Teaching and Referral Hospital Radiology and Pathology Departments from August 2017 to July 2018. It was a census study where consecutive sampling was done and 61 patients suspected to have HCC were enrolled and subjected to a Triphasic Liver CT scan. All the CT scan images were reported by the principal investigator and reviewed by two consultant radiologists. They were then subjected to image guided core biopsy for the definitive diagnosis. Data was analyzed using STATA version 13MP. Descriptive statistics were summarized using tables and graphs. Comparison of CT scan findings and histopathology was done using Chi square test and Fisher Exact test. Results: A total of 61 participants were included in the study. The youngest participant was 35 years and the oldest 72 years with a mean age of 52.7 years. On location, 59% of patients had masses in the right lobe, 34.4% in both lobes and 6.6% in the left lobe. On contrast enhancement, 63.9% of the masses were detected on the non-enhanced phase while the enhanced phases increased the detection to 100%. Of all HCC’s, 62.2% demonstrated homogenous enhancement with 32.8% being heterogeneous. Furthermore, 65.5% of HCC had CT features of cirrhosis at diagnosis and HCC was confirmed on histopathology in 88.5% of patients. Features of Cirrhosis was significantly associated with HCC p=0.004, Fisher Exact test, OR=17.1. Hyper-enhancement was significantly associated with HCC, p=0.015, Chi square test. Presence of venous washout was significantly associated with HCC, p<0.00, Chi square test. The association between presence of HCC fibrous capsule and histopathology findings was not statistically significant p=0.190, Fisher Exact test. Conclusion: Histopathology confirmed 88.5% of all radiologically diagnosed HCC. Majority of the HCC’s were in the right lobe and 65.57% of all HCC had CT features of Cirrhosis at diagnosis. Hyper-enhancing masses, venous wash out and presence of CT features of cirrhosis were significantly associated with a diagnosis of HCC. Recommendation: We should have a high index of suspicion for all hyper-enhancing liver lesions >1cm with a rapid venous washout in the setting of cirrhosis in the absence of a Liver Biopsy.