Abstract
Background and aimsTransjugular intrahepatic portosystemic shunt (TIPS) may be placed to treat complications of portal hypertension by creating a conduit between the hepatic and portal vein. The diagnosis of hepatocellular carcinoma (HCC) is typically made by multiphasic imaging studies demonstrating arterial enhancement with washout on arterial, portal venous, and delayed phase imaging. The aim of our study was to determine how the presence of TIPS would affect the imaging diagnosis of HCC.MethodsThis was a single-center electronic database review of all patients who underwent multiphasic imaging with MRI or CT scan for HCC screening between January 2000 and July 2017 and who were subsequently diagnosed with HCC. Data collected included patient demographics, liver disease characteristics including CPT score, MELD-Na, AFP, type of imaging, tumor stage, and lab values at the time of HCC diagnosis. The diagnosis of HCC was made using LI-RADS criteria on contrast-enhanced CT or MR imaging and confirmed by chart abstraction as documented by the treating clinician. Demographic and imaging characteristics for HCC patients with and without TIPS were compared.ResultsA total of 279 patients met eligibility criteria for the study, 37 (13.2%) of whom had TIPS placed prior to diagnosis of HCC. There was no significant difference in demographics or liver disease characteristics between patients with and without TIPS. Compared to cirrhotic patients with no TIPS prior to HCC diagnosis, patients with TIPS had significantly more scans with a longer duration of surveillance until HCC diagnosis. However, LI-RADS criteria and stage of HCC at diagnosis were not significantly different between both groups. There were no differences in outcomes including liver transplant and survival.ConclusionThe presence of TIPS does not lead to a delayed diagnosis of HCC. It is associated, however, with greater duration of time from first scan to diagnosis of HCC.
Highlights
Deaths from cirrhosis have increased from 1980 to 2010 [1]
The presence of Transjugular intrahepatic portosystemic shunt (TIPS) does not lead to a delayed diagnosis of hepatocellular carcinoma (HCC)
The development of cirrhosis is associated with a higher risk of developing hepatocellular carcinoma (HCC), and an estimated 80–90% of HCC cases occur in the setting of underlying cirrhosis [2]
Summary
Deaths from cirrhosis have increased from 1980 to 2010 [1]. The development of cirrhosis is associated with a higher risk of developing hepatocellular carcinoma (HCC), and an estimated 80–90% of HCC cases occur in the setting of underlying cirrhosis [2]. HCC can be diagnosed by multiphasic imaging studies that demonstrate characteristic arterial enhancement with washout on arterial, portal venous, and delayed phase images, which has been standardized using Liver Reporting and Data System (LI-RADS) criteria [6,7]. The presence of portal vein thrombosis, which alters venous flow within the liver, has been associated with a more advanced stage of HCC at the time of diagnosis [8]. In patients with HCC and portal vein thrombosis, there is a possibility of a lack of characteristic arterial hypervascularity, which may be secondary to compensatory increased arterial supply to the background liver [9]. The diagnosis of hepatocellular carcinoma (HCC) is typically made by multiphasic imaging studies demonstrating arterial enhancement with washout on arterial, portal venous, and delayed phase imaging.
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