J Korean Soc Radiol.  2014 May;70(5):335-342. 10.3348/jksr.2014.70.5.335.

Hepatic Angiographic Findings of Ruptured Hepatocellular Carcinoma: "Sentinel Signs" versus Extravasation

• Yun SJ
• Nam DH

• KMID: 1941777
• DOI: http://doi.org/10.3348/jksr.2014.70.5.335

Abstract

PURPOSE
This study retrospectively compared the accuracy of angiographic sentinel signs (sentinel vessels, hypovascular areas, and delayed dots) with extravasation in the diagnosis of ruptured hepatocellular carcinoma (HCC).
MATERIALS AND METHODS
Sixteen patients diagnosed with HCC between March 2007 and November 2011 were evaluated. Among the patients, we identified 32 HCCs (19 ruptured, 13 unruptured), and assessed all HCCs by hepatic angiography with regard to extravasation, sentinel vessels, hypovascular areas, and delayed dots. We compared the sensitivity and specificity of the sentinel signs with those of the extravasation for the diagnosis of a ruptured HCC.
RESULTS
For the angiographic diagnosis of a ruptured HCC, the sensitivity of the sentinel signs (sentinel vessel, 63.2%; hypovascular area, 89.5%; delayed dot, 72.7%) was higher than the sensitivity of extravasation (15.8%). The difference in sensitivity between each sentinel sign and extravasation was statistically significant (sentinel vessel, p = 0.012; hypovascular area, p < 0.001; delayed dot, p = 0.039). The specificity of sentinel signs for the diagnosis of ruptured HCC was not statistically different from the specificity of extravasation.
CONCLUSION
Sentinel signs are more accurate than extravasation for the angiographic diagnosis of a ruptured HCC.

MeSH Terms

Angiography
Carcinoma, Hepatocellular*
Diagnosis
Embolization, Therapeutic
Extravasation of Diagnostic and Therapeutic Materials
Humans
Retrospective Studies
Rupture, Spontaneous
Sensitivity and Specificity

Figure

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  Fig. 1 Flow chart of patient selection. Note.-HCC = hepatocellular carcinoma, TAE = transcatheter arterial embolization

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  Fig. 2 Sentinel vessel. A 50-year-old male with hepatocellular carcinoma rupture at liver segment 5. On hepatic angiogram, abnormal dilatated and tortuous peripheral vessels (arrows) are seen in comparison with proximal segmental vessels.

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  Fig. 3 Surrounding hypovascular area and delayed dot. A 64-year-old male with hepatocellular carcinoma (HCC) ruptured liver segment 4. Hepatic angiogram shows a barely staining area (black straight arrows) in hypervascular stain and dot like residual contrast stains (white straight arrows). This is different from usual HCCs which show hypervascular staining (curved arrows).

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