Department of Radiology - BiND, University Hospital "Paolo Giaccone", Palermo, Italy.
Department of Radiology, AP-HP, Hôpital Beaujon, Clichy, Hauts-de-Seine, France;INSERM U1149 "centre de recherche sur l'inflammation", Université de Paris, Paris, France.
Diagn Interv Radiol. 2020 Nov;26(6):531-540. doi: 10.5152/dir.2020.19569.
Hepatocellular carcinoma (HCC) is frequently associated with macrovascular invasion of the portal vein or hepatic veins in advanced stages. The accurate diagnosis of macrovascular invasion and the differentiation from bland non-tumoral thrombus has significant clinical and management implications, since it narrows the therapeutic options and it represents a mandatory contraindication for liver resection or transplantation. The imaging diagnosis remains particularly challenging since the imaging features of HCC with macrovascular invasion may be subtle, especially in lesions showing infiltrative appearance. However, each radiologic imaging modality may provide findings suggesting the presence of tumor thrombus rather than bland thrombus. The purpose of this paper is to review the current guidelines and imaging appearance of HCC with macrovascular invasion. Knowledge of the most common imaging features of HCC with macrovascular invasion may improve the diagnostic confidence of tumor thrombus in clinical practice and help to guide patients' management.
肝细胞癌（HCC）在晚期常伴有门静脉或肝静脉的大血管侵犯。准确诊断大血管侵犯并将其与良性非肿瘤性血栓区分开来具有重要的临床和管理意义，因为这会缩小治疗选择范围，并且是肝切除术或肝移植的强制性禁忌证。由于大血管侵犯的 HCC 的影像学特征可能不明显，尤其是表现为浸润性外观的病变，因此影像学诊断仍然具有特别大的挑战性。然而，每种影像学检查方法都可能提供提示肿瘤血栓而不是良性血栓存在的发现。本文旨在回顾大血管侵犯的 HCC 的现行指南和影像学表现。了解大血管侵犯的 HCC 的最常见影像学特征可以提高临床实践中对肿瘤血栓的诊断信心，并有助于指导患者的管理。
