Differential Diagnosis for Hepatocellular Carcinoma (HCC) Based on Contrast Enhancement Patterns
Single most likely diagnosis:
- Arterially enhancing, hypoenhancing (to surrounding liver) on the following phases: This pattern is highly suggestive of HCC, as these tumors typically show rapid enhancement during the arterial phase due to their hypervascular nature and then become hypoenhancing in the portal venous and delayed phases as the contrast washes out.
Other Likely diagnoses:
- Peripheral nodular enhancement on post-contrast phases: This could be seen in HCC, especially in the early stages or in smaller lesions, but it's not as specific as the arterially enhancing, hypoenhancing pattern.
- Arterially enhancing, isoenhancing on following phases: While less typical for HCC, some well-differentiated HCCs might show this pattern, making it a consideration in the differential diagnosis.
Do Not Miss (ddxs that may not be likely, but would be deadly if missed):
- None of the provided options directly fit into the "do not miss" category based on the typical enhancement patterns of HCC. However, it's crucial to consider other aggressive liver lesions like cholangiocarcinoma or metastases, which might have varying enhancement patterns, including hypoenhancement on all phases, especially if the clinical context suggests an alternative diagnosis.
Rare diagnoses:
- Gradual enhancement, filling from periphery to central portion over subsequent phases: This pattern is more characteristic of hemangiomas, which are benign liver lesions.
- Hypoenhancing on all phases: While this could be seen in some cases of HCC, especially poorly differentiated ones, it's a non-specific finding that could also represent other diagnoses such as metastases or cholangiocarcinoma. In the context of looking for HCC, this pattern would be less typical and might suggest alternative diagnoses.