Masumi Kadoya, MD Osamu

#{149} Matsui, MD Tsutomu

#{149} Takashima, MD Akitaka
#{149} Nonornura, MD

Hepatocellular Carcinoma:
Correlation ofMR Imaging
and Histopathologic Findings’

Seventy-two histologically proved R ECENT advances in ultrasound were confirmed

specimens.
by means of resected
Transcatheter arterial emboli-
nodular hepatocellular carcinomas (US) and computed tomography
(HCCs) were studied with magnetic (CT) have made it possible to detect zation therapy was not performed in any
resonance (MR) imaging at 1.5 T. hepatocellular carcinomas (HCCs) lesion before MR imaging and histologic
confirmation.
Capsules were present
in 56 of the 72 smaller than 2.0 cm in diameter. How-
tumors. Thirty-seven capsules were ever, the imaging characteristics of
depicted on Ti-weighted spin-echo HCCs are occasionally nonspecific, Imaging Technique
MR images, and 16 were depicted on and differentiation from noncancer-
T2-weighted MR images. Visualiza- ous small nodular lesions of the liver, MR imaging was performed with a su-
tion was dependent on thickness and regenerative nodules, and adenoma- perconducting magnet (Signa; GE Medical
Systems, Milwaukee) operating at 1.5 T. A
structure of the capsules. Of the 72 tous hyperplastic nodules (AHNs) in
spin-echo (SE) pulse sequence was em-
tumors, 36 had a mosaic pattern. A the cirrhotic liver (so-called tumor-
ployed, with a repetition time of 500 msec
mosaic pattern was visualized in 12 like lesions) with US, CT, and angiog- and an echo time of 20 msec (SE 500/20)
of the 36 tumors on fl-weighted im- raphy is difficult (1). for TI-weighted images and SE 2,500/80
ages and in 27 of the 36 tumors on Recent reports have demonstrated for T2-weighted images. Four signal acqui-
T2-weighted images. Six tumors were that HCCs have a characteristic ap- sitions were used with Ti-weighted imag-
determined to be histologic grade 1, pearance on magnetic resonance ing and two with T2-weighted imaging.
and all were hyperintense on Ti- (MR) images (2-4). However, to our Images were acquired with a 128 x 256 or
weighted images, regardless of knowledge, the correlation between 256 x 256 matrix for both Ti- and T2-
whether intracellular fat deposits the MR imaging and histopathologic weighted imaging. Multiple sections were
simultaneously obtained in the transverse
were present Four of the six grade 1 findings of HCC has not yet been
plane in all patients. The section thickness
tumors were isointense on T2- evaluated completely (2). In this was 10 mm, with 2.5-5-mm intersection
weighted images. In contrast, grades study, we analyzed the MR imaging gaps. Motion artifact was reduced with
2 and 3 tumors had various signal appearance of HCC in relation to the respiratory ordered phase encoding (Exor-
intensifies on fl-weighted images macroscopic features (eg, capsule and cist; GE Medical Systems) and spatial pre-
and most were hyperintense on T2- mosaic pattern) and evaluated the saturation of flowing blood. A flow com-
weighted images. Twenty-one of 32 correlation between signal intensity pensation technique was not used.
tumors (66%) with focal areas of in- and histologic findings of HCC.
creased signal intensity on T2-
weighted images had intratumoral Pathologic Analysis
dilated sinusoids at histologic exami- MATERIALS AND METHODS HCCs were evaluated for the presence
nation. of two gross characteristics (5), a fibrous
Subjects
capsule, and a so-called mosaic pattern
From April 1987 to March 1990, MR im- (macroscopic inhomogeneity of tumor
Index terms: Liver neoplasms, 761.321 Liver
#{149}
neoplasms, diagnosis Uver neoplasms,
#{149} MR aging was performed in 63 patients (48 and/or the presence of intratumoral fi-
761.1214 male patients and 15 female patients aged brous septa). All specimens were exam-
12-80 [mean, 60.3] years) with 72 histologi- med microscopically with hematoxylin-
Radiology 1992 183:819-825 cally confirmed HCCs. These lesions were eosin (H-E), Azan, and Prussian blue
confirmed by means of resection (70 le- stains. The degree of differentiation of the
sions) or autopsy (two lesions). The imag- tumor cells was classified as grades 1-4 on
ing examinations and histologic confirma- the basis of the classification used by Ed-
tion were performed within 4 weeks of mondson and Steiner (6). The structural
each other in all patients. Twenty-six tu- pattern of the tumors was divided into
mors were smaller than 2.0 cm in diame- four types with the World Health Organi-
ter, 16 were between 2.0 and 3.0 cm, and zation dassification (7), as follows: (a) tra-
30 were 3.0 cm or larger. The smallest tu- becular, in which the tumor cells grow in
1 From the Departments of Radiology (M.K, mor was 0.7 cm in diameter, and the larg-
O.M., T.T.) and Pathological Section (A.N.), est was 13.0 cm. All but two patients (with
Kanazawa University Schoolof Medicine, 13-1
two lesions) had associated liver cirrhosis
Takara-machi, Kanazawa City, 92OJapan. Re-
ceived May 10, 1991; revision requestedJune 26;
or chronic hepatitis. One patient with one
final revision received February 13, 1992; ac- lesion had underlying diffuse fatty liver, Abbreviations: AHN = adenomatous hyper-
cepted February 21. Address reprint requests to and another patient with one lesion had plastic nodule, HCC = hepatocellular carci-
M.K associated diffuse hemosiderosis. These noma, H-E = hematoxylin-eosin, SE = spin
C RSNA, 1992 changes of surrounding liver parenchyma echo.
a. b. c.
Figure 1. Large HCC with thick capsule and intratumoral hemorrhage. (a) Histologic section (Azan stain; original magnification, x 50) reveals
that the capsule surrounding the tumor (T) is composed of thick, fibrous tissue. The fibrous component is more abundant in the inner layer
(IL) than the outer layer (OL). (b) Ti-weighted MR image (SE 500/20) shows the capsule (arrow) as a hypointense ring around the tumor.
(c) T2-weighted MR image (SE 2,500/80) shows the capsule (arrow) as a double-layered ring (hypointense inner layer and hyperintense outer
layer). The HCC is associated with hemorrhage, which is seen as an area of hyperintensity within the tumor in b and an area of heterogeneous
signal intensity in c.

cords of variable thickness separated by

prominent sinusoids (blood spaces) lined Table 1
by flat endothelial cells; (b) pseudoglandu- Correlation between Tumor Diameter, Capsule Thickness, and Signal Intensity
lar, in which a variety of glandlike struc- Signal Intensity of Capsules Tumor Diameter (cm)
tures are seen; (c) compact, in which the No. of Capsule
tumor cells grow in apparently solid Ti-weighted T2-weighted Lesions < 2.0 2.0 to < 3.0 3.0 Thickness
masses and the blood spaces are rendered Imaging Imaging (n = 56) (n = 14) (n = 15) (n = 27) (mm)
inconspicuous by compression; and
ND ND 19 10 6 3 0.7 ± 0.3
(d) scirrhous, in which areas with abun-
Hypointense ND 21 3 7 11 1.4 ± 0.5
dant fibrous stroma separate cords of Hypointense Hypointense 13 1 2 10 2.7 ± 0.7
tumor cells. Hypointense Hypointense,
The presence or absence of fatty meta- hyperintense* 3 0 0 3 4.6 ± 1.0
morphosis, necrosis, hemorrhage, and iron
deposits in the tumors was also analyzed. Note-ND = not detected.
* Inner layer was hypointense and outer layer was hyperintense.
Furthermore, the presence or absence of
wide and regular dilatation of the sinu-
soid, peliotic change of blood spaces in the
tumor, was evaluated.
RESULTS diameter and 29% (four of 14 HCCs)
for tumors less than 2.0 cm in diame-
Image Analysis Capsule
ter (x2p < .05). For T2-weighted im-
The capsule was determined to be Capsules were identified at histo- aging, the detection rate was 36% (15
present (positive) when a ringlike struc- logic examination in 56 of the 72 of 42 HCCs) for tumors 2.0 cm or
ture was identified around the tumor on HCCs (78%), including 27 of the 30 more in diameter and 7% (one of 14
MR images, and the mosaic pattern was HCCs larger than 3.0 cm in diameter HCCs) for tumors less than 2.0 cm in
present (positive) when the tumor (90%), 15 of the 16 HCCs between 2.0 diameter (x2 D < .05). The difference
showed nonuniform signal intensity or
and 3.0 cm (94%), and 14 of the 26 in the capsule detection rate with Ti-
a linear-like structure of hypointensity
HCCs smaller than 2.0 cm (54%) (Ta- and T2-weighted imaging was statisti-
was demonstrated in the tumor.
Visually, the signal intensities of cir- ble 1). The capsules tended to become cally significant, especially with tu-
rhotic livers and chronic hepatitic livers thicker as tumor size increased. At mors measuring 2.0 cm or more
without fat deposition or hemosiderosis histopathologic examination, all cap- (McNemar test, P < .0001; 95% con-
were not different from those of normal sules were composed of two layers: fidence interval, 0.28-0.58).
livers. The signal intensity of a lesion was, an inner layer rich in fibrous compo- The capsules were divided into
therefore, qualitatively assessed relative to nent and an outer layer containing four groups on the basis of visualized
that of surrounding liver parenchyma. various numbers of compressed small patterns on Ti- and T2-weighted im-
The signal intensity of the largest area of a
vessels and newly formed bile ducts ages. The difference in capsular thick-
lesion was chosen for classification pur-
(Fig la). The inner layers were thinner ness of the three groups was statisti-
poses and was described as hypointense,
than the outer layers in all capsules. cally significant (Student t test,
isointense, or hyperintense.
Thirty-seven of the 56 capsules P < .05). On Ti-weighted images,
(66%) were detected on Ti-weighted capsules were seen as uniform, hy-
Statistical Analysis MR images, and 16 (29%) were de- pointense rings (Fig ib) when they
tected on T2-weighted images. For were at least 1.4 mm ± 0.5 thick. On
Analysis of the results was conducted
with use of the McNemar test (8), x2 test Ti-weighted imaging, the detection T2-weighted images, 13 capsules 2.7
(Fisher exact probability), and Student rate of the capsules was 79% (33 of 42 mm ± 0.7 thick were seen as hypoin-
test. HCCs) for tumors 2.0 cm or more in tense rings, and three thicker capsules

820 Radiology
#{149} June 1992
 crotic. Two of these three lesions were
hypointense and one was hyperin-
tense on Ti-weighted images. Two of
the three lesions were hypointense on
T2-weighted images (Fig 3) and one
(of liquefied necrosis) was hyperin-
tense.
Intracellularfat deposits and tumor
grade versus signal intensity.-Signal
intensity was analyzed in the 67 non-
necrotic tumors. Six of the 67 tumors
(9%) contained fat in all or most of the
tumor cells. All six tumors with fat
deposits were hyperintense on Ti-
weighted images (Fig 4). On T2-
weighted images, five lesions were
hyperintense and one lesion was
isointense (Table 4).
Figure 2. HCC with mosaic pattern. (a) Histologic macrosection (H-E stain) reveals intratu- Six of the HCCs were classified as
moral septa as well as capsule. (b) T2-weighted MR image (SE 2,500/80) shows two compart- grade 1 tumors (well-differentiated
ments with different degrees of hyperintensity. Arrow = tumor. HCCs) with the system used by Ed-
mondson and Steiner (6). All six grade
i tumors, regardless of whether fat
deposits were present in the cells,
Table 2 were hyperintense on Ti-weighted
Mosaic Patterns images. Classical HCCs defined as
Presence of Mosaic Presence of Mosaic grade 2 or above had various signal
Pattern at Pattern at intensities on Ti-weighted images.
Tumor Ti-weighted Imaging T2-weighted Imaging
Diameter No. of
Frequency of hyperintensity on Ti-
(cm) Lesions Positive Negative Positive Negative weighted images was significantly
higher (x2 P < .05) in grade 1 tumors
<2.0 4 1 3 0 4 (iOO%; six of six tumors) than in
2.Oto<3.0 7 3 4 4 3
3.0 25 8 17 23 2 grades 2 and 3 tumors (28%; i7 of 6i
tumors). On T2-weighted images,
Total 36 12 24 27 9
four (67%) of the six well-differenti-
ated HCCs appeared isointense and
two (33%) appeared hyperintense
(Fig 5), whereas all grades 2-4 tumors
(4.6 mm ± 1.0) were demonstrated as at least 3.0 cm in diameter (McNemar were hyperintense on T2-weighted
double-layered rings (hypointense test, P < .OOi; 95% confidence inter- images. Frequency of hyperintensity
inner layer and hyperintense outer val, 0.40-0.80). on T2-weighted images was signifi-
layer) (Fig ic). cantly higher (x2 P < .05) in grades
2-4 tumors (100%; 6i of 61 tumors)
than in grade i tumors (33%; two of
Mosaic Pattern Correlation between Signal
six tumors).
Intensity and Histopathologic
A mosaic pattern was grossly iden- Structural pattern versus signal inten-
Findings
tified in 36 of 72 tumors (50%) (Fig sity.-The correlation between the
2a), including 25 of the 30 tumors 3.0 Two of the 72 tumors were ex- structural pattern and signal intensity
cm or more in diameter (83%), seven cluded from the assessment of signal of tumors was assessed in 6i lesions
of the i6 tumors between 2.0 and 3.0 intensity (one was associated with (excluding the tumors associated with
cm in diameter (44%), and four of 26 diffuse fatty liver and the other with necrosis or fatty metamorphosis) (Ta-
tumors smaller than 2.0 cm (i5%) underlying hemosiderosis). ble 5). A trabecular pattern was domi-
(Table 2). Intratumoral linear-like struc- Tumor size versus signal intensity.- nant in 59 of the 6i tumors (97%).
lures of hypointensity were demon- Tumors revealed various signal inten- These tumors had various signal in-
strated in 12 of the 36 tumors (33%) sities on Ti-weighted images (hypoin- tensities on Ti-weighted images; 56
on Ti-weighted images. On T2- tense in 29 of the 70 cases [4i%J, were hyperintense and three were
weighted images, 27 of the 36 tumors isointense in 17 [%1, and hyperin- isointense on T2-weighted images. A
(75%) showed nonuniform signal in- tense in 24 [34%]). In contrast, 64 of pseudoglandular pattern was domi-
tensity (Fig 2b). A mosaic pattern was the tumors (9i%) appeared hyperin- nant in only two lesions, one of which
depicted in 23 of the 30 tumors 3.0 cm tense on T2-weighted images. How- was hypointense and the other isoin-
or more in diameter (77%). In con- ever, the difference in signal inten- tense on Ti-weighted images. The
trast, only one of the four mosaic sity was not significant statistically difference in signal intensity be-
patterns in tumors smaller than 2.0 (x2 J > .05) for the tumor size ( < 2.0 tween the trabecular and pseudoglan-
cm (25%) was demonstrated on Ti- vs 2.0 cm) for either Ti- or T2- dular types was not statistically signif-
weighted images. The difference in weighted images (Table 3). icant (x2 P > .05) for either Ti- or T2-
the detection rate of mosaic patterns Tumor necrosis versus signal inten- weighted images. Although the two
with Ti- and T2-weighted imaging sity.-At histologic examination, three pseudoglandular-type lesions were
was statistically significant for tumors tumors were almost completely ne- hyperintense on T2-weighted images,

Volume 183 Number

#{149} 3 P.
 Table 3
Signal Intensity of HCCs Relative to Surrounding Liver Parenchyma
Lesion Ti-weighted Imaging T2-weighted Imaging
Diameter No. of
(cm) Lesions Hypointense Isointense Hyperintense Hypointense Isointense Hyperintense

<2.0 25 9(36) 7(28) 9(36) 1(4) 2(8) 22(88)

2.Oto <3.0 16 5(31) 3(19) 8(50) 1(6) 2(13) 13(81)
3.0 29 15(52) 7(24) 7(24) 0(0) 0(0) 29(100)
Total 70 29 (41) 17(24) 24 (34) 2 (3) 4 (6) 64(91)

Note-Data are numbers of HCCs. Numbers in parentheses are percentages.

the degree of hyperintensity was

marked in one lesion in which larger
pseudoglandules were prominent
(Fig 6). A compact or scirrhous pat-
tern was not dominant in any tumors.
Intratumoral hemorrhage and iron de-
posits versus signal intensity-Five of
the 67 tumors assessed for signal in-
tensity showed gross hemorrhage. #{149}1’
Prussian blue stain was positive in
only some hemorrhagic portions of
the tumors. Parts of the hemorrhage
in the tumors appeared iso- or hy-
perintense on Ti-weighted images,
and hyper- or hypointense on T2-
weighted images. However, each
hemorrhagic area occupied only a a. b.

portion of the tumor, and the hemor- Figure 3. Necrotic HCC. (a) T2-weighted image (SE 2,500/80) shows tumor as a hypointense
lesion (arrow). (b) Histologic section shows almost complete necrosis of the tumor (T). C =
rhages did not affect the classification
capsule, L = surrounding liver parenchyma. (H-E stain; original magnification, xSO.)
of the signal intensities of the tumors
(Fig i).
Peliotic change of intratumoral sinus-
oid versus signal intensity-Twenty- perintensity on T2-weighted images with abundant small vessels and
two of the 72 tumors (3i%) showed and revealed no definite peliotic newly formed bile ducts (Fig ia). It is,
peliotic change of intratumoral sinus- change; the peliotic change was therefore, reasonable that the cap-
oid. Conversely, localized spotty or present in only one of the other four sules were demonstrated as single
tubular foci with marked hyperinten- tumors with localized hyperintense hypointense rings surrounding tu-
sity were identified in 32 of the 72 tu- foci on T2-weighted images. mors on Ti-weighted images (SE 500/
mors (44%) on T2-weighted images 20) (Fig ib) and as double-layered
(Table 6). The peliotic change was rings (hypointense inner layer and
DISCUSSION
identified at histologic examination in hyperintense outer layer) on T2-
2i of these 32 tumors (66%) (Fig 7). In One of the gross pathologic charac- weighted images (SE 2,500/80) (Fig
contrast, only one of the 40 tumors teristics of HCC is a capsule surround- ic) (4). The thin capsules were, how-
without localized hyperintense foci ing the tumor (5). Transcatheter arte- ever, demonstrated as a hypointense
on T2-weighted images revealed the rial embolization has been reported to ring on T2-weighted images even
peliotic change; signal intensity voids be more effective in encapsulated though the inner layers were thinner
were demonstrated on T2-weighted than uncapsulated HCCs (9). There- than the outer layers. This might be
images in this tumor. The correlation fore, the delineation of the capsule is due to paucity of vessels and bile
between peliotic change and localized important not only for the differential ducts in the thin outer layers relative
hyperintense foci on T2-weighted diagnosis but also from a therapeutic to the thick layers.
images was statistically significant (x2 viewpoint. In this study, as in previ- Another gross pathologic character-
P < .05). ous studies (2-4), Ti-weighted imag- istic of HCC is a mosaic appearance,
From the viewpoint of tumor size, ing was very sensitive in the detection caused by the presence of intratu-
28 of 46 tumors (6i%) at least 2.0 cm of capsules and is considered to be moral septa and/or histologic variety
in diameter had localized hyperin- useful in the differential diagnosis, within the tumor (5) (Fig 2a, Table 2).
tense foci on T2-weighted images, especially in tumors larger than 2.0 Ti-weighted imaging was not sensi-
and 20 of those 28 (7i%) revealed the cm in diameter (Table i). tive in the depiction of the mosaic
peliotic change. The peliotic change The visibility of a tumor capsule at pattern because the septa were too
was significantly (x2. J) < .05) corre- MR imaging is thought to be influ- thin to be demonstrated and most of
lated with localized hypermtense foci enced by its thickness and structure. the tumors appeared homogeneous
on T2-weighted images. Conversely, The capsules were composed of two despite the histologic inhomogeneity
22 of the 26 tumors smaller than 2.0 layers: an inner layer rich in fibrous of the tumors. In contrast, T2-
cm (85%) were of homogeneous hy- tissue and an outer, water-rich layer weighted imaging demonstrated the

822 Radiology
#{149} lune 1992
 Table 4
Correlation between Tumor Grade, Fatty Metamorphosis, and Signal Intensity in 67 Nonnecrotic Tumors
No. of Lesions Signal Inten sity on Ti-weig hted Images Signal Inten sity on T2-weig hted Images
Tumor No. of with Fatty
Grade Lesions Metamorphosis Hypointense Isointense Hyperintense Hypointense Isointense Hyperintense

1 6 3 0 0 6* 0 4 2
land2 4 0 1 1 2 0 0 4
2 46 3 19 14 i3* 0 0 46
2and3 7 0 4 2 1 0 0 7
3 4 0 3 0 i 0 0 4

Total 67 6 (9) 27 (40) i7 (24) 23 (34) 0 (0) 4 (6) 63(94)

Note-Numbers in parentheses are percentages.

* Three lesions had fatty metamorphosis.
t One lesion had fatty metamorphosis.
t Both lesions had fatty metamorphosis.

quently, the relative signal intensity

of fat-bearing tissue to water-bearing
tissue becomes stronger at higher
fields. It had been reported that Ti-
weighted SE images are insensitive to
fat deposits in the tissue (i4). This is
: considered to be true only for Ti-
weighted SE images obtained at low
. ‘.L’,
field strengths (14). Our results mdi-
cate that Ti-weighted SE imaging at
i.5 T is sensitive in the detection of fat
. L.. ‘,
deposits in HCC cells.
For the specific diagnosis of fat de-
: #{149}
posits in the tumor cells, chemical
. , -,.

shift imaging (i5) can help determine

the cause of high signal intensity on
a. b. conventional Ti-weighted SE images.
Figure 4. HCC with abundant fat deposition. (a) Ti-weighted MR image (SE 500/20) shows Of the various techniques available
hypenntense tumor (arrow). (b) Histologic section demonstrates abundant fat deposits in cy- for chemical shift imaging, the phase-
toplasm of HCC cells. T = tumor, L = surrounding liver parenchyma. (H-E stain; original contrast technique with gradient-echo
magnification, x50.) imaging (i6) seems to be clinically
useful because it is not time consum-
ing.
mosaic pattern more clearly because hypovascular. Therefore, the diagno- We found that all grade i HCCs
adjacent parts revealed different de- sis of small HCCs on the basis of find- were hyperintense on Ti-weighted
grees of hyperintensity (Fig 2b). ings at US, CT, or angiography is diffi- images (Fig 5a), regardless of whether
In general, necrotic areas are cult. When a tumor is hyperintense fat deposits were present in the cells.
thought to be hypointense on Ti- on Ti-weighted images, the diagnos- Moreover, as previously reported,
weighted images and hyperintense tic possibilities can be narrowed to AHNs with or without atypia are also
on T2-weighted images because Ti lipomatous tumors, AHN (ii), hepatic hyperintense on Ti-weighted images
and T2 relaxation times are prolonged adenoma (i2), melanoma, hemor- (ii). However, some HCCs classified
due to increase of free water in ne- rhagic tumors, and HCC. as grades 2 and 3 also appeared hy-
crotic tissue relative to liver paren- Ebara et al (2) have shown that perintense on Ti-weighted images,
chyma (iO). In our study, however, HCCs with steatosis have isointensity, although the frequency of hypermn-
two HCCs with coagulation necrosis hyperintensity, or mixed intensity on tensity on Ti-weighted images was
were hypointense on T2-weighted Ti-weighted images obtained at 0.i or significantly lower than that in the
images (Fig 3); therefore, free water 0.26 T. Conversely, in our study, all grade i tumors. We speculate that
may decrease in coagulation necrosis. HCCs with fatty metamorphosis ap- hyperintensity on Ti-weighted im-
In our study, as in previous studies peared hyperintense on Ti-weighted ages is a feature of hyperplastic
(2-4), HCCs were seen as hypoin- images (Fig 4, Table 4). We believe changes of the hepatocytes but is not
tense or hyperintense lesions on Ti- that the difference in the two studies useful for histologic grading.
weighted images; 37% of HCCs is attributable to differences in the On T2-weighted images, all grades
smaller than 2.0 cm in diameter were field strength
of the magnets used. It 2 and 3 HCCs were hyperintense, and
hyperintense on Ti-weighted images is known that the field dependence of the frequency of hyperintensity was
(Table 3). This finding is useful for the Ti in adipose tissue is markedly dif- substantially higher in these tumors
differential diagnosis of hepatic tu- ferent from that in the other tissues than in the grade i tumors. In a previ-
mors because the frequency of capsu- composed of water (i3). A linear fit to ous study, AHNs without atypia were
lar formation and mosaic appearance the field dependence of Ti yields a hypointense on T2-weighted images
in small HCCs is low (Tables i, 2). lower slope for adipose tissue than for (ii). In a recent study, AHNs with
Moreover, small HCCs are usually water-bearing tissues (i3). Conse- atypia tended to be isointense on T2-

Volume 183 Number

#{149} 3 Radiology 823
#{149}
 :_ ::k ‘ .4

“?
... .. f
,#{149}_ ‘

*t.,,_ .4.

. .- :
:s ,..,-, ‘...

‘ .

;.;,
#{149}; .‘#{149}‘..

,,#{149} 4,., , .1

1:.#{149}

#{149}j.’.#{149} -
- ., #{149}I#{149}, - . . #{149}4

a. b. c.
Figure 5. Well-differentiated HCC without fat deposition. (a) Ti-weighted MR image (SE 500/20) shows hyperintense tumor (arrow). (b) T2-
weighted MR image (SE 2,500/80) shows isointense tumor. (c) Histologic section shows grade 1 HCC and no definite fat deposits. (H-E stain;
original magnification, x500.)

Table 5
Correlation between Structural Patterns of HCCs and Signal Intensity
Dominant Signal Inte nsity on Ti-weig hted Images Signal Inte nsity on T2-weig hted Images
Structural No. of
Pattern Lesions Hypointense Isointense Hyperintense Hypointense Isointense Hyperintense

Trabecular 59 (97) 26 16 i7 0 3 56
Pseudoglandular 2 (3) 1 1 0 0 0 2

Total 61 27 17 17 0 3 58

Note-A compact or scirrhous pattern was not dominant in any tumors. Numbers in parentheses are percentages.

weighted images (Matsui 0, unpub-

lished data, i990). We believe, there-
fore, that the signal intensity on T2-
weighted images may correlate with
the grade of malignancy in hepato-
cytic nodular lesions in the cirrhotic
liver, and that the combination of
signal intensities on Ti- and T2-
weighted images is useful in their dif-
ferential diagnosis and the evaluation
of their histologic grade. However, it
is uncertain what histologic factors
correlate with the differences in signal
intensities among these hepatocytic
nodular lesions.
Differences in the structural pat- a. b.
terns of HCCs may affect the volume Figure 6. HCC with dominant pseudoglandular pattern. (a) T2-weighted MR image (SE
of extracellular water existing prima- 2,500/80) demonstrates the tumor as a markedly hyperintense lesion (arrows). (b) Histologic
section reveals a variety of glandlike structures. (H-E stain; original magnification, x50.)
rily as free water and, consequently,
the signal intensity of the tumors on
MR images. Compared with HCCs
with a trabecular pattern, one of the already well known (i8). In this gests that hemosiderin does not con-
HCCs classified as pseudoglandular study, hemorrhagic areas in the tu- tribute to the signal intensity of non-
was markedly hyperintense on the mors had various signal intensities on hemorrhagic HCCs. In fact, in an in
T2-weighted image (Fig 6). At histo- MR images. However, each hemor- vitro study (i9), we reported that the
logic examination, large acini were rhagic area occupied only a portion of lack of iron accumulation in HCCs
densely and diffusely present within the tumor. Therefore, we believe that can be exploited as a contrast in HCCs
the tumor. As reported by Ohtomo et hemorrhages do not affect the degree arising in iron-positive AHNs at MR
al (i7), the prolonged T2 is considered of signal intensity of the tumors. imaging, and Mitchell et al (20) re-
to be due to abundant fluid present in Moreover, Prussian blue staining ported that iron-free HCCs within
the acini. demonstrated hemorrhage in only siderotic nodules are delineated as
The MR findings of hemorrhage are some portions of the tumors; this sug- small foci of intermediate signal in-

824 #{149}
Radiology June 1992
 4. Itoh K, Nishimura K, Togashi K, et al.
Table 6 Hepatocellular carcinoma: MR imaging.
Correlation of Peliotic Change and Localized Hypenntensity on T2-weighted Radiology 1987; 164:21-25.
SE Images 5. Kojiro M, Nakashima T. Pathology of
hepatocellular carcinoma. In: Okuda K,
Presence of Presence of Localized Ishak KG, eds. Neoplasms of the liver. To-
Tumor Peliotic Change Hyperintense Foci kyo: Springer, 1987; 81-104.
Diameter No. of 6. Edmondson HA, Steiner PE. Primary car-
(cm) Lesions Positive Negative Positive Negative cinoma of the liver: a study of 100 cases
among 48,900 necropsies. Cancer 1954;
<2.0 26 1 25 4 22 7:462-503.
2.Oto <3.0 16 3 13 7 9 7. Gibson JB. Histological typing of tumors
3.0 30 18 12 21 9 of the livers, biliary tract and pancreas. In:
Total 72 22 50 32 40 International histological classification of
tumors. Vol 20. Geneva: World Health Or-
ganization, 1978.
8. Dwyer AJ. Matchmaking and McNemar
in the comparison of diagnostic modalities.
Radiology 1991; 178:328-330.
9. Sakurai M, Okumura J, Kuroda C. Trans-
catheter chemoembolization effective for
treating hepatocellular carcinoma: a his-
topathologic study. Cancer 1984; 54:387-
392.
10. Mitchell DC, Burk D Jr, Vinitski S, et al.
The biophysical basis of tissue contrast in
extracranial MR imaging. AJR 1987; 149:
831-837.
11. Matsui 0, Kadoya M, Kameyama T, et al.
Adenomatous hyperplastic nodules in the
cirrhotic liver: differentiation from hepato-
cellular carcinoma with MR imaging. Radi-
ology 1989; i73:123-126.
12. Gabata T, Matsui 0, Kadoya M, et al. MR
imaging of hepatic adenoma. AJR 1990;
155:1009-1011.
13. Johnson GA, Herfkins RJ, Brown AA. Tis-
sue relaxation time: in vivo field depen-
dence. Radiology 1985; 156:805-810.
Figure 7. HCC with peliotic change of intratumoral sinusoid. (a) T2-weighted MR image 14. Stark DD, Goldberg HI, Moss AA, et al.
(SE 2,500/80) demonstrates hyperintense foci (arrows) in HCC. (b) Histologic section reveals Chronic liver disease: evaluation by mag-
dilated sinusoids (peliotic change) in the tumor. (H-E stain; original magnification, xSOO.) netic resonance. Radiology 1984; 150:149-
151.
15. Dixon WT. Simple proton spectroscopic
imaging. Radiology 1984; 153:189-194.
tensity within low-signal-intensity cannot be correlated with peliotic 16. Wehrli FW, Perkins TG, Shimakawa A, et
nodules on clinical MR images. changes in the tumors, but they are al. Chemical shift-induced amplitude
We found a correlation between thought to be the major cause of lo- modulations in images obtained with gra-
dient refocusing. Magn Reson Imaging
peliotic changes of intratumoral si- calized hyperintense foci seen on T2- 1987; 5:157-158.
nusoids and localized hyperintense weighted images, especially in tumors 17. Ohtomo K, Itai Y, Minami M, et al. Hepa-
foci on T2-weighted images (Table 6). larger than 2.0 cm in diameter. tocellular carcinoma: MR appearance mim-
In general, vessels with fast flow icking cavernous hemangioma. J Comput
Assist Tomogr 1990; 14:650-652.
show signal intensity loss on T2- Acknowledgments: We express our deep ap-
18. Gomori JM, Grossman RI. Head and neck
weighted images (iO). In this study, preciation to our colleagues Jun Yoshikawa,
hemorrhage. In: Kressel HY, ed. Magnetic
MD, Kazunori Arai, MD, Toshifumi Gabata, MD,
loss of signal intensity was demon- resonance annual 1987. New York: Raven,
Kazuhiko Ueda, MD, Ken-ichi Kobayashi, MD,
strated in only one tumor, despite the 1987; 71-112.
Masashi Unoura, MD, Ryohei Izumi, MD, Kazuo
19. Terada T, Kadoya M, Nakanuma Y, et al.
fact that a flow compensation tech- Hashimoto, MD, Masashi Miura, MD, and Tsuy-
Iron-accumulating adenomatous hyper-
nique was not used. The flow of di- oshi Mitsui, MD, for their valuable contribu-
plastic nodule with malignant foci in the
tions. We also thank Hayumi Dejima and John
lated sinusoids in the tumors seemed cirrhotic liver: histopathologic, quantitative
Gelbium for their kind assistance in preparing
to be different from that of the sup- iron, and magnetic resonance imaging: in
the manuscript.
vitro studies. Cancer 1990; 65:1994-2000.
plying artery and was rather slow.
20. Mitchell DC, Rubin R, Siegelman ES, et al.
Because cavernous hemangiomas are References Hepatocellular carcinoma with siderotic
demonstrated as markedly hyperin- 1. Matsui 0, Kadoya M, Kameyama T, et al. regenerative nodules: appearance as a
tense foci on T2-weighted images Imaging diagnosis of hepatocellular carci- nodule within a nodule on MR images. Ra-
(2i), peliotic changes of intratumoral nomas. Jpn J Cancer Chemother 1989; 16: diology 1991; 178:101-103.
25-33. [Japanesel 21. Stark DD, Felder RC, WittenbergJ, et al.
sinusoids are believed to be hyperin-
2. Ebara M, Ohto M, Watanabe Y, et al. Di- Magnetic resonance imaging of cavernous
tense on T2-weighted images because agnosis of small hepatocellular carcinoma: hemangiomas of the liver: tissue-specific
of the slow flow of blood in them (Fig correlation of MR imaging and tumor his- characterization. AJR 1985; 145:213-222.
7). All localized hyperintense foci in tologic studies. Radiology 1986; 159:371-
377.
the tumors on T2-weighted images
3. Itai Y, Ohtomo K, Furui S, et al. MR imag-
ing of hepatocellular carcinoma. J Comput
Assist Tomogr 1986; 10:963-968.

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