Tests and Diagnosis

Computed tomography (CT)

The CT scan is an x-ray test that produces detailed cross-sectional images of your body. A CT scan of the abdomen can help identify many types of liver tumors. It can provide precise information about the size, shape, and position of any tumors in the liver or elsewhere in the abdomen, as well as nearby blood vessels. CT scans can also be used to guide a biopsy needle precisely into a suspected tumor (called a CT-guided needle biopsy). If you are found to have liver cancer, a CT of your chest may also be done to look for possible spread to the lungs.

A CT scanner has been described as a large donut, with a narrow table in the middle opening. You will need to lie still on the table while the scan is being done. CT scans take longer than regular x-rays, and you might feel a bit confined by the ring while the pictures are being taken.

For this test, you may be asked to drink 1 to 2 pints of a liquid called oral contrast. This helps outline the intestine so that certain areas are not mistaken for tumors. You may also receive an IV (intravenous) line through which a different kind of contrast (IV contrast) is injected. This helps better outline structures in your body. The injection can cause some flushing (redness and warm feeling). Some people are allergic and get hives or, rarely, more serious reactions like trouble breathing and low blood pressure. Be sure to tell the doctor if you have any allergies or ever had a reaction to any contrast material used for x-rays.

If your doctor suspects you may have liver cancer, you may have one set of CT scans of your abdomen taken before you get IV contrast. Other sets of scans may then be taken over the next several minutes as the contrast passes through the liver and other parts of the body. These sets of scans (together known as a 3-phase, 4-phase, or multiphase CT scan) can sometimes help tell a benign tumor from a malignant one.

Magnetic resonance imaging (MRI)

Like CT scans, MRI scans provide detailed images of soft tissues in the body. But MRI scans use radio waves and strong magnets instead of x-rays. The energy from the radio waves is absorbed and then released in a pattern formed by the type of body tissue and by certain diseases. A computer translates the pattern into a very detailed image of parts of the body.

When MRI is used to look at liver tumors, several sets of images may be taken. After the first set is done, a contrast material called gadolinium is injected into a vein to help see details more clearly. Then other sets are taken over the next several minutes as the contrast moves through the liver and other parts of the body. This is known as 3-phase, 4-phase, or dynamic contrast-enhanced MRI.

MRI scans can be very helpful in looking at liver tumors. Sometimes they can tell a benign tumor from a malignant one. They can also be used to look at blood vessels in and around the liver, and can help show if liver cancer has spread to other parts of the body.

MRI scans may be a little more uncomfortable than CT scans, and they often take longer. You may be placed inside a narrow tube, which is confining and can upset people with a fear of enclosed spaces. Special more open MRI machines can sometimes be used instead, but the drawback is that the pictures may not be as clear. The MRI machine also makes buzzing and clicking noises that you may find disturbing. Some places will provide earplugs to help block these noises out.

Angiography

An angiogram is an x-ray test that looks at blood vessels. Contrast medium, or dye, is injected into an artery to outline blood vessels while x-ray images are taken. Angiography can be used to show the arteries that supply blood to a liver cancer, which can help doctors decide if a cancer can be removed and to help plan the operation. It can also be used to help guide some types of non-surgical treatment, such as embolization (see the section "Embolization therapy for liver cancer").

Angiography can be uncomfortable because a small catheter (a flexible hollow tube) must be put into the artery leading to the liver to inject the dye. Usually the catheter is put into an artery in your groin and threaded up into the liver artery. You have to stay very still while the catheter is in place. A local anesthetic is often used to numb the area before inserting the catheter. Then the dye is injected quickly to outline all the vessels while the x-rays are being taken.

Angiography may also be done with a CT scanner (CT angiography) or an MRI scanner (MR angiography). These techniques are often used instead of x-ray angiography because they can give information about the blood vessels in the liver without the need for a catheter in the artery. You will still need an IV line so that a contrast dye can be injected into the bloodstream during the imaging.

Bone scan

A bone scan can help look for cancer that has spread (metastasized) to bones. Doctors don′t usually order this test for people with liver cancer unless you have symptoms such as bone pain, or if there′s a chance you may be eligible for a liver transplant to treat your cancer.

For this test, a small amount of low-level radioactive material is injected into a vein (IV). The substance settles in areas of damaged bone throughout the entire skeleton over the course of a couple of hours. You then lie on a table for about 30 minutes while a special camera detects the radioactivity and creates a picture of the skeleton.

Areas of active bone changes appear as "hot spots" on the skeleton – that is, they attract the radioactivity. These areas may suggest the presence of cancer, but other bone diseases can also cause the same pattern. Other tests such as plain x-rays or MRI scans, or even a bone biopsy might be needed to know what is causing any hot spots.