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2016, Number S1

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Acta Med 2016; 14 (S1)

Advances on hepatic imaging: cholangiocarcinoma and hepatocellular carcinoma

González-Vergara C, Mancilla-Mazariegos S

Language: Spanish
References: 27
Page: 45-54
PDF size: 826.53 Kb.


ABSTRACT

Hepatocellular carcinoma is the most common primary malignant neoplasm of the liver and the fifth most frequent world wide. Underlying risk factors are viral hepatitis C and B, as well as alcoholic hepatitis and steatohepatitis related to metabolic syndrome. A high elevation of serum α-fetoprotein exists, however certain patients may present normal or discretely elevated levels. Ultrasound is usually the imaging study used for initial detection and its role is oriented to surveillance and detection in high-risk patients. Multiphasic contrast-enhanced CT and MR reinforce the vascular features; arterial phase conveys tumoral angiogenesis, wash-out appearance and the usage of hepatospecific contrast agents are now reference points in international guidelines to forego percutaneous biopsy. The main differential diagnosis is intrahepatic cholangiocarcinoma, which is the second primary hepatic tumor in the world. The main risk factor is biliary chronic inflammation, with well established pre-malignant injuries and, different than hepatocellular carcinoma, it has no specific tumoral markers. Classification of cholangiocarcinoma is according to location and growth patterns. The first includes intrahepatic, Klatzkin tumors (perihiliar) and extrahepatic or distal. Growth patterns are mass forming, periductal infiltrating and intraductal. Other imaging modalities for diagnosis include: MR cholangiography, endoscopic and percutaneous cholangiography.


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