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- Title
Assessment of factors affecting washout appearance of hepatocellular carcinoma on CT.
- Authors
Hwang, Jeong Ah; Min, Ji Hye; Kang, Tae Wook; Jeong, Woo Kyoung; Kim, Young Kon; Ko, Seong Eun; Choi, Seo-Youn
- Abstract
Objectives: To identify independent imaging and histopathologic factors that affect washout appearance of hepatocellular carcinoma (HCC) in CT images. Methods: This retrospective study included 264 patients who had undergone surgical resection for treatment-naïve single HCC between January 2014 and December 2015 and had available preoperative multiphasic CT images. Two reviewers evaluated the CT imaging features of HCC using LI-RADS v2018. The "washout" was visually assessed in portal venous or equilibrium phases. Depending on the presence of washout appearance of HCC, all patients were divided into "washout" (n = 228) and "no washout" (n = 36) groups. Multivariable logistic regression analysis was used to identify factors associated with the absence of washout appearance of HCC. Results: A total of 264 HCCs (median size, 2.6 cm) were analyzed. Histologically proven hepatic steatosis (macrovesicular steatosis ≥ 5%) (odds ratio [OR], 2.65; 95% confidence interval [CI], 1.05–6.74; p = 0.040), tumor capsule on histopathology (OR, 0.17; 95% CI, 0.06–0.50; p = 0.001), and mosaic appearance on CT image (OR, 0.34; 95% CI, 0.14–0.85; p = 0.021) were independent factors associated with the absence of washout appearance of HCC. In 189 patients with available unenhanced CT images, CT-diagnosed hepatic steatosis was also an independent factor for the absence of washout appearance of HCC (OR, 9.26; 95% CI, 3.06–28.02; p < 0.001). Conclusions: Washout appearance of HCC in CT images could be obscured in both histologically proven hepatic steatosis and CT-diagnosed hepatic steatosis, and could be enhanced with tumor capsule on histopathology and mosaic appearance on CT image. Key Points: • Hepatic steatosis is an independent factor related to the absence of washout appearance of hepatocellular carcinoma in CT images, in both histologically proven hepatic steatosis and CT-diagnosed hepatic steatosis. • Both histologically proven hepatic steatosis and CT-diagnosed hepatic steatosis have higher odds of absence of washout appearance of hepatocellular carcinoma compared to non-steatotic liver. • Tumor capsule on histopathology and mosaic appearance on CT image are independent factors that enhance the probability that washout appearance of hepatocellular carcinoma is visible.
- Publication
European Radiology, 2021, Vol 31, Issue 10, p7760
- ISSN
0938-7994
- Publication type
Article
- DOI
10.1007/s00330-021-07897-8