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Objective The aims of this study are to compare the multiphasic contrast-enhanced computed tomography (CECT) characteristics of infiltrative hepatocellular carcinoma (HCC) with nodular HCC and to assess the conspicuity of infiltrative HCC on different phases of CECT. Materials and Methods This retrospective study comprised consecutive treatment-naive cirrhotic patients diagnosed with infiltrative and nodular HCC between January 2020 and December 2021 based on a multiphasic CECT (comprising arterial, portal venous, and delayed phases). The diagnosis of HCC was based on the Liver Imaging Reporting and Data System (LI-RADS) v2018 criteria (LR-4 and LR-5 lesions). Infiltrative HCCs are characterized by large, irregular, permeative lesions spread over multiple liver segments or lobes. Nodular HCCs comprise well-defined tumor nodules. Two radiologists independently reviewed all CT images. Additionally, lesion conspicuity on the arterial, portal venous, and delayed phases was assessed. Results One hundred fifty-eight patients (117 nodular and 41 infiltrative HCCs; mean age: 55.6 ± 17.2 years; 90 [56.9%] males) were included. Arterial phase hyperenhancement, portal venous/delayed phase washout, and delayed phase enhancing capsule were significantly associated with nodular HCCs (p = 0.002, 0.0001, and <0.0001, respectively). Portal vein, hepatic vein thrombosis, biliary dilatation, and ascites were significantly associated with infiltrative HCCs (p < 0.0001, 0.004, <0.0001, and 0.003, respectively). The interobserver agreement for the conspicuity of infiltrative HCC was the highest for the delayed phase (weighted kappa = 0.611). Conclusion Infiltrative HCCs show the major LI-RADS features less frequently compared with nodular HCCs, and venous thrombosis is an important clue to the diagnosis. The delayed phase of multiphasic CECT is critical to identifying these lesions. [ABSTRACT FROM AUTHOR]

Objective The aims of this study are to compare the multiphasic contrast-enhanced computed tomography (CECT) characteristics of infiltrative hepatocellular carcinoma (HCC) with nodular HCC and to assess the conspicuity of infiltrative HCC on different phases of CECT.

Background and Aims: We assessed clinical, procoagulant and genetic risk factors and clinical outcomes in dabigatran-treated patients with non-tumoural acute and acute-on-chronic portal vein thrombosis (PVT)., Methods: Patients with a new diagnosis of non-tumoural acute and acute-on-chronic PVT between January 2021 and January 2024 (aged ≥ 18 years) in those without/with cirrhosis (Child-Pugh (CP)-A/B/C ≤ 10) were started on dabigatran and followed and compared with those on vitamin K antagonist (VKA) and untreated individuals., Results: Dabigatran was prescribed in 119 patients with PVT type 1 (61, 51.3%), type 2 (34, 28.6%), type 3 (24, 20.2%); 72 (60.5%) with cirrhosis [CP-A (27, 37.5%), CP-B (43, 59.7%) and CP-C10 (2, 2.8%)]. Procoagulant factors noted were JAK2V617F (10.1%), CALR (2.5%) and factor V Leiden (1.6%) mutations, antiphospholipid syndrome (APS, 15.2%), isolated Protein C (14.3%) and Protein S (16.8%) deficiency., Comparators: 28 patients who declined anticoagulation/were unable to come for follow-up, and six with CP-C received VKA. Overall recanalization rate (RR) on dabigatran was 56 (47.1%); 25 (21%) complete recanalization, 31 (26%) partial recanalization and 63 (52.9%) stable PVT over median follow-up of 32 months. Patients not anticoagulated had a spontaneous RR in 21.4% (28 patients; p = 0.005 compared with dabigatran group) and none recanalized on VKA. On multivariable analysis, predictors of recanalization on dabigatran were Factor VIII Antigen level (FVIII:Ag, HR 0.6; 95% CI 0.3-0.9, p = 0.032), non-occlusive PVT (HR 3.5, 95% CI 1.9-5.6, p = 0.025) and acute PVT (HR 2.1; 95% CI 1.5-3.2, p = 0.003). Mortality was 14 (11.8%)., Conclusion: On dabigatran, 47% of 119 patients achieved portal vein recanalization over 32 months of follow-up which was higher than the spontaneous RR (21.4%) in an untreated cohort. High Factor VIII:Ag was a predictor of non-recanalization. Dabigatran was safe in cirrhosis (CP-A and B) while further work is needed in CP-C., (© 2025 John Wiley & Sons Ltd.)