Celiac Angiography in the Diagnosis of Small Hepatocellular Carcinoma
Celiac angiography is indispensable in the diagnosis of hepatic tumors, particularly hepatocel-lular carcinoma (HCC). The characteristic, if not pathognomonic, angiographic findings of HCC include tumor vessels, bizarre vascular lakes or conduits, hypervascularity, arterioportal shunts, and intraportal tumor invasion [1–5], identified as the thread and streaks sign . However, these findings are derived from studies of advanced cases of HCC. With the advent of various newer imaging techniques, the diagnostic significance of angiography is changing. Currently, small HCCs are mostly detected by ultrasonography (US) in Japan and Taiwan and perhaps in some regions of China and Southeast Asia. The established diagnostic policy for early detection of HCC in these areas has been to follow patients with chronic liver disease by regularly scheduled checkups using abdominal US and serum alpha-fetoportein (AFP) measurements [7–9]. Small lesions are often detected among such patients and the lesions mostly prove to be HCC. The usual sequence of diagnostic investigations that follow the detection of a small-mass lesion by US involves CT scan followed by angiography and, finally, perhaps by US-guided biopsy . Although CT scan and angiography are not sufficiently sensitive for the demonstration of lesions smaller than 2 cm, both modalities are necessary, particularly the latter, in patients under consideration for an operation or hepatic resection. The following discussion summarizes our experience with angiography in the diagnosis of HCC smaller than 5 cm in diameter.
KeywordsTumor Vessel Cirrhotic Liver Angiographic Finding Small Hepatocellular Carcinoma Hepatic Arteriography
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