Preliminary Diagnosis: Hepatocellular Carcinoma
I. What imaging technique is first-line for this diagnosis?
Triple phase CT of the liver
II. Describe the advantages and disadvantages of this technique for diagnosis of hepatocellular carcinoma.
Advantages
- Gold standard in liver imaging
- Adequately able to detect and differentiate all hepatic lesions
- May help direct biopsy and treatment
- Better able to characterize the primary process and detect any secondary complications than other imaging modalities
- Highly sensitive and specific in detecting and characterizing liver lesions
- Offers exquisite visualization of the surrounding soft tissues and osseous structures
Disadvantages
- Exposes patients to ionizing radiation
- Less portable than ultrasound imaging
III. What are the contraindications for the first-line imaging technique?
- Relative contraindication in pregnant women
IV. What alternative imaging techniques are available?
- Ultrasound of the liver
- Contrasted MR of the liver and abdomen
V. Describe the advantages and disadvantages of the alternative techniques for diagnosis of hepatocellular carcinoma.
Ultrasound of the liver
Advantages
- Highly portable imaging modality
- Does not expose patients to ionizing radiation
- Highly adept in detailing the vascularity of a liver lesion
- May be helpful in guiding percutaneous biopsy of a liver lesion
Disadvantages
- Has limited sensitivity and specificity in evaluating liver lesions
Contrasted MR of the liver and abdomen
Advantages
- Does not expose patients to ionizing radiation
- Highly adept in detecting and differentiating liver lesions
Disadvantages
- Expensive
- Long image acquisition time and exposes patients to ionizing motion artifact and susceptibility weighted artifact
- Less adept evaluation of the surrounding osseous structures than other imaging modalities
- Less adept in guiding percutaneous treatment than other imaging modalities
VI. What are the contraindications for the alternative imaging techniques?
Ultrasound of the liver
- No specific contraindications to sonographic imaging exist.
Contrasted MR of the liver and abdomen
- Contraindicated in patients with non-MR compatible hardware
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