Clinicopathological characteristics
According to Japanese classification, 5 patients were classified as B1 BDTT, 12 patients B2, 13 patients B3, and 82 patients B4 in the present study, respectively. The incidence of HCC with BDTT was 1.4% (112/7753), B1-B3 BDTT was account for 26.8% (30/112).
The clinicopathological characteristics of HCC patients with B1-B3 BDTT were listed in Table 1. Within this cohort, 23 of the patients were male and 7 were female. The mean age was 48.5 years with an age range of 23-76. The liver cirrhosis was found in 90.0% (27/30) of patients. Thirteen of them (27/30, 90.0%) were positive for alpha-fetoprotein (AFP) (>20 ng/dL). No patients were found having obstructive jaundice before operation. The primary tumors located at the left lobe (13 patients) or right lobe (17 patients). The average size of primary tumors was 7.4 (2.5-13.0) cm in diameter and the multiple hepatic lesions were observed in 19 patients (66.3%). Capsule formation was found in 25 patients (83.3%) and poor differentiation was observed in 18 patients (60.0%). Gross portal vein tumor thrombus (PVTT) (Vp2–Vp4) were detected in 14 (46.7%) patients. 26 (86.7%) patients underwent hemihepatectomy and 22 (73.3%) were patients with advanced HCC.
Table 1 The clinicopathological feature of 30 HCC patients with type B1-B3 BDTT Clinical information Values
Age (years) 48.5( 23-76)
Gender(male/female) 23/7
HBsAg(positive/negative) 29/1
Background liver (Nocirrhosis/Cirrhosis) 3/27
Child-pugh grade(A/B) 28/2
Total bilirubin (µmol/l) 15.9(10-25.7)
Albumin (g/L) 40.7 (29.7-50.8)
ALT(U/L) 51.8 (14-152)
AST(U/L) 60.8(17-286)
AFP (Positive/Negative) 27/3
Tumor number (Single/ Multiple) 11/19
Tumor size 7.4(2.5-13)
Capsule formation (Absent/ Present) 25/5
≥ hemihepatectomy (Yes/No) 26/4
Portal vein invasion (VP0/VP1/VP2/VP3/VP4) 16/0/4/10/0
Lymph node metastasis (Negative/ Positive) 27/3
Tumor differentiation (Well+Moderate/Poor) 12/18
TNM stage(Ⅰ/Ⅱ/Ⅲ/Ⅳ) 5/3/19/3
CT and MRI findings
18 patients received CT and 12 patients received MRI scans. The HCC lesions were detected in all patients, and the localized biliary dilation were observed in 28 patients. The BDTT was observed in all B3 patients and 3 B2 patients, but it was not observed in all B1 patients on CT or MRI. The BDTT in 13 B3 patients and 3 B2 patients showed relatively hypoattenuation on plain CT scans and T1W images, relatively hypoattenuation signals on T2W, hyperattenuation at HAP with washout at PVP.
One B1(Fig.1), nine B2 and eight B3 BDTT received CT scans. The HCC lesions showed relatively hypoattenuation on plain CT scan, hyperattenuation at HAP and hypoattenuation at PVP in all patients. The localized biliary dilation showed no enhancement at HAP and no progressively delayed enhancement at PVP, but it was more obvious at PVP.
Four B1, three B2 (Fig.2) and five B3 BDTT (Fig.3) received MRI scans. The HCC lesions and localized biliary dilation showed relatively hyperattenuation signals on T2W images and relatively hypoattenuation signals on T1W images. Early enhancement of HCC lesions at HAP with hyperattenuation signals were observed, but thickened and obviously enhanced bile duct wall were not observed in all patients. At PVP, HCC lesions showed hypoattenuation signals in nine patients and isoattenuation in three patients, and the localized bile duct dilation showed hypoattenuation signals in all patients. The localized biliary dilation was not observed in two B1 BDTT.
The imaging features of HCC with BDTT are summarized in Table 2. The primary tumor located at right anterior section (S5 and/or S8) in 12 patients, right posterior section (S6 and/or S7) in 5 patients, S2 and/or S3 in 13 patients.
Table 2 Imagine findings of 16 HCC patients with type B1-B3 BDTT
Variables Values
NO. Location of tumor Location and type of BDTT Dilation of bile duct
1 S5,S8, RAHBD B2 S5,S8
2 S3 S3 B1 S3
3 S5 RAHBD B2 S8
4 S3 LLHBD B2 S2
5 S5,S8, RAHBD B2 S5,S8
6 S2,S3 LHD B3 S4
7 S5 RHD B3 S6,S7,S8
8 S3 LLHBD B2 S2
9 S2,S3 LLHBD B2 S2,S3
10 S6S7 RHD B3 S5,S6,S8
11 S2 LLHBD B2 S3
12 S2,S3 LHD B3 S3,S4
13 S2 LLHBD B2 S3
14 S2 LHD B3 S3,S4
15 S5, S8 RHD B3 S5,S6,S7,S8
16 S2 LLHBD B1 S2
17 S5 RAHBD B2 S8
18 S6 S6 B1 No
19 S5 S5 B1 No
20 S3 LHD B3 S2,S4
21 S6 RPHBD B2 S6,S7
22 S2 S2 B2 S2,S3
23 S8 RAHBD B2 S5,S8
24 S8 RHD B3 S5,S6,S7
25 S8 VBD of S8 B1 DBD of S8
26 S5,S8 RHD B3 S6,S7,S8
27 S6 RHD B3 S5,S7,S8
28 S3 LHD B3 S2,S4
29 S7 RHD B3 S5,S6,S8
30 S5,S8 RHD B3 S6,S7
Of the thirteen B3 patients, the tumor thrombus located at left hepatic duct in five patients, right hepatic bile duct in eight patients. Of five patients with B1 BDTT, the localized biliary dilation was observed in S2, S3, S5, S6, S8, respectively. Of twelve patients with B2 BDTT, the localized biliary dilation was observed in S2 (3 patients), S3(2 patients), S2 and S3(1 patients), S6 (1 patient), S8 (1 patient), S5 and S8 (2 patients), respectively. Of thirteen patients with B3 BDTT, the localized biliary dilation was observed in right hepatic liver (8 patients) and left hepatic liver (5 patients), respectively.