Joy Einwaller, Jan Wennemuth
Background
Primary hepatic lesions in dogs, including hepatocellular carcinoma (HCC), hepatocellular adenoma (HCA), and nodular hyperplasia (NH), pose diagnostic challenges due to overlapping imaging features. Accurate differentiation is critical for guiding surgical versus nonsurgical management, as HCC carries a far worse prognosis if untreated. While histopathology remains the diagnostic gold standard, triple-phase computed tomography (CT) offers a potential noninvasive tool for distinguishing benign from malignant hepatic lesions.
Methods
This single-center study at Tierklinik Hofheim (Germany) combined retrospective and prospective analyses of dogs with histopathologically confirmed hepatic lesions (HCC, HCA, or NH) who underwent triple-phase helical CT scans. Quantitative CT parameters—lesion size and Hounsfield Units (HU) across precontrast, arterial, portal venous, and delayed phases—were compared between lesion types. Qualitative features such as enhancement pattern and surface morphology were also evaluated by two blinded radiologists. Significant features were analyzed using receiver operating characteristic (ROC) curves to establish diagnostic cutoff values and assess sensitivity, specificity, and accuracy.
Results
In the retrospective phase (36 dogs), HCCs were significantly larger (mean 11.4 cm vs. 7.9 cm; p = 0.008) and showed lower HU in portal venous and delayed phases than benign lesions (p < 0.001). Cutoff values predictive of HCC included:
-Maximum transverse diameter > 9.8 cm (AUC = 0.73)
-Portal venous phase HU < 136 (AUC = 0.87)
-Delayed phase HU < 108 (AUC = 0.86)
-Heterogeneous enhancement pattern (AUC = 0.7)
When these criteria were combined, diagnostic accuracy reached 89% with a positive predictive value of 91%.
In the prospective phase (57 dogs), applying the same criteria yielded an overall accuracy of 86%, sensitivity of 90%, and specificity of 79%.
Limitations
Limitations included variable contrast administration rates, potential variability in region-of-interest selection, and the exclusion of other benign and malignant hepatic lesions. Additionally, few NH cases limited the representativeness of that group. Manual contrast injections in small dogs introduced further variability in HU measurements.
Conclusions
Triple-phase CT provides reliable differentiation of HCC from HCA and NH in dogs. Key predictors of malignancy include lesion size >9.8 cm, portal venous HU <136, delayed-phase HU <108, and heterogeneous enhancement. These criteria achieved approximately 90% predictive accuracy, supporting triple-phase CT as a valuable noninvasive diagnostic adjunct for canine hepatic masses. Broader studies encompassing additional lesion types are warranted to confirm and extend these findings.
Arterial, portal venous, and delayed postcontrast computed tomographic images of the cranial abdomen in transverse views, comparingthe enhancement characteristics of hepatocellular adenoma (top row) and hepatocellular carcinoma (bottom row). Note the homogeneous enhancementpattern of the hepatocellular adenoma compared with the heterogeneous enhancement pattern of the hepatocellular carcinoma, being most pronouncedin the portal venous and delayed phase.
How did we do?
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