Computer tomography findings among adult patients with suspected hepatocellular carcinoma at Muhimbili national hospital

Abstract

Background: Liver cancers account for 6% of the worlds cancer incidence, 9% of the global cancer mortality burden and the second most common cause of death due to cancer worldwide. Of the primary hepatic malignancies, HCC accounts for 80% of cases. HCC primarily affects males more than females. HCC is mostly associated with chronic liver disease or cirrhosis. There is classical HCC and its variants. Objectives: To determine the role of CT radiological patterns in the management of adult patients with clinically diagnosed hepatic mass at MNH from December 2015 - March 2016. Methodology: Patients with clinically diagnosed hepatic mass who underwent abdominal CT scan examination were included in the study. The images were examined and reported by the principal investigator together with a Radiologist. The report was issued after reaching a consensus. Results: A total of seventy four (74) patients were involved in this study. HCC was seen in twenty seven (36.0 %) patients. HCC was non-significantly associated with males (45.00% vs. 26.47%, p-value= 0.099) and in patients 60 years and below (47.62% vs. 32.08% %, p-value= 0.216). Radiological features of HCC included a shrunken liver (18.52% vs. 2.13%, p-value= 0.013) and nodular liver appearance (33.33% vs. 0%, p-value= 0.000) in HCC. Heterogeneous mass attenuation (33.33% vs. 12.77%, p-value= 0.034), irregular mass margins (74.07% vs. 55.32%, p-value= 0.109), complex mass properties (40.74% vs. 70.21%, p-value= 0.013) with mainly solid content predominance (66.67% vs. 29.79%, p-value= 0.002). Post contrast images showed HCC with heterogeneous enhancement pattern to be 33.33% vs. 8.51% (p-value= 0.007), ascites (48.15% vs. 19.15% p-value= 0.009) and less likely para-aortic lymph nodes (7.41% vs. 17.02% p-value= 0.244). Conclusion: HCC is well described by non-contrasted and contrasted abdominal CT scan examinations. HCC was mainly affecting males and patients aged 60 years and below. HCC mainly presents with a shrunken liver, nodular liver outline, heterogeneously attenuating complex masses with irregular outline, predominantly solid with heterogeneous enhancement, peripheral fat stranding, ascites and less likely para-aortic lymphadenopathy. Recommendations: It is recommended a larger sample size to be used in future studies.