Usefulness of Whole Body MRI detecting extrahepatic metastasis of HCC: Three case reports

Extrahepatic metastatic lesions of hepatocellular carcinoma (HCC) that cannot be detected using CT, positron emission tomography-CT, and bone scintigraphy, have often been encountered in the clinical setting. Recently, whole body (WB) -MRI using diffusion weighted images (DWI) has been recommended for the detection of metastases of various malignancies. We reported three HCC patients in whom extrahepatic metastases were detected using this modality. Patient 1 showed elevation in the tumor marker after HCC resection. Her peritoneal disseminated lesion was detected not with CT but with WB-MRI using DWI. Patient 2 complained of lumbago during sorafenib treatment. Bone scintigraphy revealed multiple bone metastases; however, WB-MRI using DWI could detect more lesions. Patient 3 showed deteriorating intrahepatic lesions and elevated tumor marker. Bone metastases in the right upper arm and right thigh were detected using WB-MRI with DWI. WB-MRI using DWI may be a useful diagnostic option for identifying extrahepatic metastasis of HCC.