Department of Radiology, University of Texas Medical Branch, Galveston, TX 77555, United States of America.
Department of Radiology, University of Texas Medical Branch, Galveston, TX 77555, United States of America.
Clin Imaging. 2023 May;97:34-43. doi: 10.1016/j.clinimag.2023.03.002. Epub 2023 Mar 4.
Hepatocellular carcinoma (HCC) is the 5th most common neoplasm and the 3rd leading cause of cancer related mortality worldwide. Early stages of the neoplasm may be treated curatively with liver resection or orthotopic liver transplant. However, HCC has a high propensity for vascular and locoregional invasion, which can preclude these treatment options. The portal vein is the most invaded structure, while other regional structures affected include the hepatic vein, inferior vena cava, gallbladder, peritoneum, diaphragm, and the gastrointestinal tract. Management of invasive and advanced stages of HCC includes modalities such as transarterial chemoembolization (TACE), transarterial radioembolization (TARE), and systemic chemotherapy, which are non-curative and focus on relieving tumor burden and slowing progression. A multimodality imaging approach is effective in identifying areas of tumor invasion and distinguishing between bland and tumor thrombi. Due to implications in prognosis and management, it is imperative for radiologists to accurately identify imaging patterns of regional invasion by HCC and to distinguish between bland and tumor thrombus in cases of potential vascular invasion.
肝细胞癌 (HCC) 是全球第 5 常见的肿瘤，也是第 3 大癌症相关死亡原因。肿瘤的早期阶段可以通过肝切除术或原位肝移植进行治愈性治疗。然而，HCC 具有很高的血管和局部侵袭性，这可能会排除这些治疗选择。门静脉是最常被侵犯的结构，而受影响的其他区域结构包括肝静脉、下腔静脉、胆囊、腹膜、膈肌和胃肠道。侵袭性和晚期 HCC 的治疗方法包括经动脉化疗栓塞 (TACE)、经动脉放射栓塞 (TARE) 和全身化疗等方法，这些方法是非治愈性的，主要侧重于减轻肿瘤负担和减缓进展。多模态成像方法可有效识别肿瘤侵犯区域，并区分良性和肿瘤血栓。由于对预后和管理的影响，放射科医生必须准确识别 HCC 的区域侵犯的影像学模式，并在存在潜在血管侵犯的情况下区分良性和肿瘤血栓。
