الفهرس 
IntroductionOnly 14 pages are availabe for public view
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Abstract
Liver computed tomography play an important role in the early detection of hepatocellular carcinoma. However, the American Association for the Study of Liver Diseases (AASLD) recommend the use of applied imaging studies for HCC diagnosis only in cirrhotic patients. This study aimed to identify role of dynamic CT in differentiation between hepatic focal lesions of hepatocellular and non-hepatocellular origin in cirrhotic patients. This study included total number of 100 patients with hepatic cirrhosis and discovered focal lesions by ultrasonography as a primary screening. After obtaining a written informed consent, the cases were subjected to full history taking, clinical examination and laboratory investigations Dynamic CT (non-contrast, arterial, portal and delayed phases) was done for all patients as baseline to show the size of lesion, its location, morphology, enhancement pattern, vascular invasion, to know the texture of the rest of the liver. The results of this study showed that: • There were 33 males & 24 females diagnosed as HCC of hepatocellular origin. 43 patients were diagnosed as non-HCC lesions, 24 of them were males with a percentage of 55.8%. • 20% of patients with primary HCC had lesions located in segment VIII while only 1.8% of primary HCC patients had radiological finding of their lesions in segment I. • 31.4% of patients with non-HCC lesions were located in segment V lesions, with no patients diagnosed with lesions in segment I. • There were 77 lesions were capsulated, 39 of them were of hepatocellular origin with significant p value (0,.019). necrosis was found in 26 patients of hepatocellular origin and only 7 patients of non-hepatocellular origin with significant p value of 0.002. • There were 20 lesions associated with calcification in 1ry HCC while only 3 patients with non-HCC origin were calcified. • Portal vein invasion was diagnosed in 10 patients with HCC and only 2 non-HCC patients hade PV invasion. • Lymph nodes at porta hepatis were found to be involved in 12 HCC patients, with significant P value of 0.001. • Spleen enlargement was found in 9 non-HCC patients and removed in only one patient of them. • The mean size of HCC lesions was 23.05 which was significantly different in non-HCC lesions with mean size of 7.91. • The BL HFU in the pre arterial phase was 46.46 in HCC lesions, on the other hand it was 39.33 in non-HCC lesions. • The arterial, portal and delayed phases in HCC lesions BL HFU and SOL HFU were higher than Non-HCC lesions. • No significant difference was found between distribution of benign and malignant lesions in the different hepatic segments. • Both benign and malignant lesions which showed no P value differences in capsule, calcification, PV invasion and spleen enlargement. • Necrosis was found in 7 benign lesions with no necrosis in malignant lesions with P value of 0.036.• PH lymph nodes were enlarged in 6 malignant lesions with no affection in benign lesions. • There was a statistically significant difference in the distribution of LIRAD score between HCC and non-HCC lesions. Conclusion Dynamic liver CT is useful for distinguishing HCC from non-HCC focal lesions with high sensitivity and specificity. Delayed phase imaging is useful for detecting small HCCs and should be included in dynamic CT examinations of patients with liver cirrhosis. The key diagnostic tool in differentiation between hepatocellular and non-hepatocellular tumors can be carried out by the quantitative assessment of the RWR A-D ( Relative washout ratio from arterial to delayed phases) which was found to be of cut off point 28.34 that help in characterization of the hepatic tumors.