Imaging of fibrolamellar hepatocellular carcinoma.

The imaging studies of 12 patients with fibrolamellar hepatocellular carcinoma were reviewed in an attempt to characterize the appearance of the tumors and to stage them. The imaging studies showed that 10 (83%) of 12 tumors were solitary, one was multilobulated with several satellite nodules, and one was bilobed. Surface lobulations were present in nine (82%) of 11 tumors on CT, five of five on sonography, and seven (88%) of eight on angiography. A central scar was identified in five (45%) of 11 tumors on CT, three (60%) of five on sonography, and two (25%) of eight on angiography. Calcification was seen in six (55%) of 11 tumors on CT, four (80%) of five on sonography, and one (13%) of eight on plain films. The tumors were correctly staged as resectable or nonresectable by CT in eight (73%) of 11 patients, by sonography in four (80%) of five, and by angiography in five (63%) of eight. Understaging was responsible for all but one of the staging errors. Distinguishing fibrolamellar hepatocellular carcinoma from more common hepatocellular carcinoma can affect surgical planning and survival.