Diagnostic imaging for hepatocellular carcinoma

Abstract

Hepatocellular carcinoma (HCC) occurs mostly in individuals with cirrhosis, which is why the guidelines of the most important scientific societies indicate that these patients are included in surveillance programs through the repetition of an ultrasound examination every 6 months. The aim is to achieve early identification of the neoplasia in order to increase the possibility of curative therapies (liver transplantation, surgery or local ablative therapies) and to increase patient survival. HCC nodules arising in cirrhotic livers show characteristic angiographic behavior that can be evaluated with dynamic multidetector computed tomography and dynamic magnetic resonance imaging (MRI). However, the use of these techniques in real life is often hindered by the lack of uniform terminology in reporting and in the interpretation of the exams reflected in the impossibility of comparing examinations performed in different centers and/or at different times. Liver Imaging Reporting and Data System® was created to standardize reporting and data collection of computed tomography and MRI for HCC. In some cases HCC arises in patients with healthy livers and, although there is evidence that angiographic behavior is not different from cirrhotic patients in this clinical situation, the guidelines still indicate the execution of a biopsy. Frequent use of palliative therapeutic techniques such as transarterial chemoembolization, transarterial radioembolization or administration of antiangiogenic drugs (sorafenib) poses problems of interpretation of the therapeutic response with repercussions on the subsequent choices that have been attempted to resolve with the use of stringent criteria such as Modified Response Evaluation Criteria In Solid Tumors.

Effects of Multiple Filters on Liver Tumor Segmentation From CT Images

“…In particular, the value of a in [1,2], the value of b in [1, 1.2] and the value of g in [1.5, 2] of each case. We used the mean value of the image as the threshold value for applying these a, b, and g values corresponding with specialized cases.…”

“…Currently, indistinct nodular HCCs are the smallest type of HCC that can be clinically detected. The goals of evaluating a hepatic nodule on CT images in a patient with liver cirrhosis include not only identifying the nature of the lesion but also estimating the hepatic extension of the neoplasia and any possible localization in extrahepatic sites (2). From there, a clinician can propose a suitable treatment based on the exact staging of the disease.…”

Hydralazine‐augmented contrast ultrasound imaging improves the detection of hepatocellular carcinoma

“…In cirrhotic patients, its sensitivity is 33%-86%. 12 This wide variation is related mainly to the image quality and experience of the operator, patient-related factors such as body habitus and cooperativeness, and tumor-related factors including tumor size, internal tumor echo-intensity pattern, and tumor location in the liver with diffuse fibro-cirrhotic. 13 Contrast-enhanced ultrasound (CUS) was introduced in the early 2000s to characterize nodules arising in cirrhotic livers.…”

“…However, the accuracy of HCC detection with conventional B‐mode US varies widely. In cirrhotic patients, its sensitivity is 33%–86% 12 . This wide variation is related mainly to the image quality and experience of the operator, patient‐related factors such as body habitus and cooperativeness, and tumor‐related factors including tumor size, internal tumor echo‐intensity pattern, and tumor location in the liver with diffuse fibro‐cirrhotic 13 …”

Sonographic appearance of focal liver lesions and likelihood of hepatocellular carcinoma in adult Thais with chronic hepatitis B virus infection

“…[4][5][6] US screening for HCC has a sensitivity of 33%-96% and specificity of 90%-97%, depending on HBV prevalence and various factors such as operator experience, patient habitus, and US technology. 7,8 However, the main challenge to detect early HCC size <2 cm which appearance of small HCC may mimic common other benign lesions such as hemangioma, nodule-like focal fat sparing, focal nodular hyperplasia. 9,10 Current studies reveal that the ultrasound images found in HCC do not have specific characteristics [11][12][13] and are commonly overlapped with other benign lesions.…”