Highly enhanced hepatic masses seen on CT during arterial portography: Early hepatocellular carcinoma and adenomatous hyperplasia

Background: To describe computed tomographic (CT) features of highly enhanc ed hepatic masses as seen on CT during arterial portography (CTAP) and to s urvey the varieties of hepatic lesions associated with such findings. Methods: CTAP files for 400 patients were reviewed, on the basis of which s ix patients with highly enhanced hepatic masses were selected. These six pa tients also subsequently underwent CT during hepatic arteriography (CTHA) o n the same day. All the patients had chronic liver damage, which was cirrho tic in five cases. Five had a current diagnosis and one had a history of he patocellular carcinoma (HCC), Results: Solitary highly enhanced masses were observed on CTAP in three pat ients, three masses were seen in one patient and multiple (10-12) masses in the other two patients. All the CTAP-enhanced masses except one were round in shape and homogeneous in attenuation. The size of the mass ranged from 6 to 25 mm in diameter. In all except two nodules in one patient, the masse s were hypoattenuated on CTHA. On histopathological examination of five nod ules in three patients, the nodular lesions were consistent with so-called early HCC (well-differentiated HCC of Edmondson I) in four nodules and aden omatous hyperplasia in the other nodule, Conclusions: Highly enhanced hepatic masses relative to the surrounding liv er parenchyma have been sporadically noted on CTAP, especially in patients with liver cirrhosis, When present, such nodules are typically hypoattenuat ed on CTHA and histological features are consistent with early HCC and aden omatous hyperplasia.