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Современные подходы к диагностике и лечению гепатоцеллюлярного рака

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Представлен анализ современных подходов к диагностике и лечению гепатоцеллюлярного рака (ГЦР). Приведены сведения о его распространенности, основных клинических проявлениях и лабораторных показателях. Кратко описываются микро- и макроскопические разновидности данной опухоли, приведена ее гистологическая классификация. Подробно отражены особенности и варианты отображения ГЦР при УЗИ, РКТ и МРТ. Подчеркивается исключительно важная роль применения динамического внутривенного контрастирования и анализа особенностей гемодинамики в опухоли в различные фазы исследования (артериальную, венозную и отсроченные). Подробно описаны характерные черты отображения типичных гиперваскулярных вариантов ГЦР, что позволяет уверенно диагностировать эту опухоль даже без морфологической верификации. Наиболее частым вариантом отображения ГЦР считается диффузное гетерогенное контрастирование опухоли в артериальную фазу с последующим быстрым вымыванием контрастного препарата в венозную фазу. Пункция или биопсия рекомендуются при атипичных проявлениях ГЦР, в частности при гипо- или изоваскулярных его вариантах. Приведены собственные результаты использования гепатоспецифических МР-контрастных препаратов. Описаны особенности проявлений ГЦР при диффузионновзвешенной МРТ. Упоминается роль классической (диагностической) ангиографии и позитронной эмиссионной томографии (ПЭТ/КТ). Кратко освещены возможные методы и методики лечения соответствующих пациентов, в частности с помощью различных вариантов термоабляции и трансартериальной эмболизации. Упоминаются также результаты применения дистанционной лучевой терапии и химиотерапии препаратом Сорафениб.

Ключевые слова:
гепатоцеллюлярный рак, диагностика, РКТ, МРТ.

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The Current Approaches to Diagnosis and Management of Hepatocellular Carcinoma

The current approaches to diagnostic radiology of hepatocellular carcinoma (HCC) and management of patients are being discussed. We present the most characteristic morphologic features of them, including gross pathology and histology, typical and atypical imaging findings at ultrasound (US), computed tomography (CT), and magnetic resonance (MR) imaging (including Diffusion Weighted MRI).The importance of contrast media using is reported (including hepatocyte-specific ones). We describe and illustrate the key imaging features of hepatocellular carcinoma, allowing the noninvasive diagnosis of HCC. HCC usually shows diffuse heterogeneous enhancement in the arterial phase and washout in the delayed phase. The biopsy should be performed only in atypical cases with hypo- or isovascular variants of HCC. The results of using hepatospecific contrast mediumare reported. The role and significance of Diffusion Weighted MRI is being discussed and illustrated. The role of classic transcatheter angiography and positron emission tomography (PET/CT) is mentioned. Management strategies of the affected patients are discussed shortly, namely transarterial chemoembolization, different types of thermoablation, external three-dimensional conformal radiotherapy and chemotherapy (soraphenib).

Keywords:
liver lesions diagnosis, hepatocellular carcinoma, CT, MRI.