الفهرس 
Introduction & Aim of the WorkOnly 14 pages are availabe for public view
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Abstract
Our study is a retrospective case control study aimed to study the radiological characters of hepatocellular carcinoma in chronic HCV patients received Direct Acting Antiviral Drugs compared to radiological criteria of HCC in chronic HCV patients didn’t previously treated with any antiviral.
This study was done in Tropical Medicine clinic, HCC clinic, Minia university hospital Department and Minia oncology center in the period from October 2017 to December 2018.
Three hundred and twenty consecutive patients with hepatocellular carcinoma diagnosed according to the recommendations of AASLD 2018.
All patients underwent history taking, thorough clinical examination and routine laboratory investigations in addition to radiological studies.
Triphasic MDCT scan was used to detect the typical pattern of HCC and accordingly the diagnosis of HCC is confirmed.
These 320 patients were allocated according to their past history of HCV antiviral treatment into 2 groups:
group 1: formed of 154 patients that have HCC and they completed the antiviral therapy and achieved SVR12.
Inclusion Criteria:
5. Age > 18-year-old.
6. Both males and females included.
7. Positive HCV antibodies and HCV RNA PCR.
8. Diagnosed hepatocellular carcinoma patients by triphasic MDCT scan.
Exclusion Criteria:
6. Age < 18-year-old.
7. Failure to achieve SVR 12.
8. History or current evidence of malignant tumor other than HCC.
9. Patients with extra hepatic metastasis.
10. Patients with positive HBs antigen or HIV coinfection.
A flow chart (fig 1) shows the progress of the work
group 2(control): formed of 166 patients, as a control group. They have HCC and didn’t receive any antiviral therapy before
Every patient was subjected to the following:
1-Complete history taking and clinical examination:
A-personal history (esp.age, alcohol consumption, addiction)
B- Presenting symptom (mainly: abdominal pain and symptoms of chronic liver diseases.
C- Abdominal examinations (to detect any mass, hepatomegaly,
splenomegaly, or ascites)
2-Laboratory investigations including:
- Complete blood picture.
- Liver function including (AST, ALT, Alkaline phosphatase, serum albumin, total protein, bilirubin level and INR).
- Viral markers (HCV Abs, HBsAg by ELISA).
- Kidney function tests.
- Serum alpha feto protein level by chemiluminescence immunoassay.
We compared between the two groups in the following: basic demographic and clinical data, basic laboratory data, Hepatic focal lesion (HCC) characters according to MDCT scan including number, site, size of focal lesions, PV state and splenic site.
The results were:
* We found that HCC was present mainly in male patients more than females.
* Also it was appeared that HCC present among patients in Rural area than in urban where HCV infection is more in low socioeconomic level.
* Liver enzymes (ALT & AST) were shown to be high in patients with HCV infection who previously treated with antiviral.
* AFP level was Higher in patients treated with antivirals than patients didn’t treated before. However, AFP level was high in those patients; it was found that its level is decreasing by the time.
* We found that HCC formed in patients after treatment with DAAs was more aggressive in behavior than that formed in the other group according to:
• Site: HCC in patients treated previously was found to accompany both lobes of liver, while HCC in the other group only present in one lobe.
• Number: HCC formed after treatment was more than one lesion, while HCC formed in the other group was mainly single lesion.
• Size: HCC formed after treatment was large in size shown in Triphasic CT more than the other group
*It was shown that HCC formed in patients after treatment accompanied by PV thrombosis & splenomegally more than the other grouop.
* We found that HCC formed in treated group was in class C according to BCLC staging system, which indicated its aggressiveness.
* In treated group, it was shown that time taken for appearance of the lesinon was longest in patients treated with interferon only, while it was shortest in group treated with both SOFO + DACLA.