Abstract
Early diagnosis of hepatocellular carcinoma (HCC) is crucial for optimizing treatment outcome. Ongoing advances are being made in imaging of HCC regarding detection, grading, staging, and also treatment monitoring. This review gives an overview of the current international guidelines for diagnosing HCC and their discrepancies as well as critically summarizes the role of magnetic resonance imaging (MRI) and computed tomography (CT) techniques for imaging in HCC. The diagnostic performance of MRI with nonspecific and hepatobililiary contrast agents and the role of functional imaging with diffusion-weighted imaging will be discussed. On the other hand, CT as a fast, cheap and easily accessible imaging modality plays a major role in the clinical routine work-up of HCC. Technical advances in CT, such as dual energy CT and volume perfusion CT, are currently being explored for improving detection, characterization and staging of HCC with promising results. Cone beam CT can provide a three-dimensional analysis of the liver with tumor and vessel characterization comparable to cross-sectional imaging so that this technique is gaining an increasing role in the peri-procedural imaging of HCC treated with interventional techniques.
Highlights
Liver cancer is the sixth most common cancer currently representing the third leading cause of cancer-related deaths worldwide [1]
Apart from biomarker analyses, imaging performed by computed tomography (CT), magnetic resonance imaging (MRI) and ultrasonography (US) with or without intravenous contrast administration plays an essential role for early detection of Hepatocellular cancer (HCC)
Guidelines proposed by EASL and AASLD recommend a diagnostic algorithm which is primarily based on the tumor size, whereas the Eastern guidelines follow an algorithm starting from the arterial enhancement characteristics [10]
Summary
Liver cancer is the sixth most common cancer (approximately 750,000 new cases per year) currently representing the third leading cause of cancer-related deaths worldwide [1]. Bota et al [10] have given an excellent overview about the current status of guidelines for HCC summarizing similarities and differences between the latest guidelines regarding the non-invasive diagnosis of HCC They discuss guidelines proposed by the American Association for the Study of. Important differences in non-invasive HCC diagnosis among the Western and Eastern guidelines are reported: Concerning the most appropriate imaging modality for the diagnosis of HCC, different approaches are recommended by the aforementioned four guidelines: the AASLD and EASL guidelines exclusively accept a four-phase contrast-enhanced computed tomography (CT) and/or a dynamic contrast-enhanced magnetic resonance imaging (DCE-MRI), whereas the APASL and Japanese guidelines allowcontrast-enhanced ultrasound (CEUS). The Japanese guidelines propose the use of liver specific MR contrast media
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