Hepatocellular Carcinoma: Illustrated Guide to Systematic Radiologic Diagnosis and Staging According to Guidelines of the American Association for the Study of Liver Diseases

Abstract

Hepatocellular carcinoma is a malignancy that predominantly occurs in the setting of cirrhosis. Its incidence is rising worldwide. Hepatocellular carcinoma differs from most malignancies because it is commonly diagnosed on the basis of imaging features alone, without histologic confirmation. The guidelines from the American Association for the Study of Liver Diseases (AASLD) are a leading statement for the diagnosis and staging of hepatocellular carcinoma, and they have recently been updated, incorporating several important changes. AASLD advocates the use of the Barcelona Clinic Liver Cancer (BCLC) staging system, which combines validated imaging and clinical predictors of survival to determine stage and which links staging with treatment options. Each stage of the BCLC system is outlined clearly, with emphasis on case examples. Focal liver lesions identified at ultrasonographic surveillance in patients with cirrhosis require further investigation. Lesions larger than 1 cm should be assessed with multiphasic computed tomography or magnetic resonance imaging. Use of proper equipment and protocols is essential. Lesions larger than 1 cm can be diagnosed as hepatocellular carcinoma from a single study if the characteristic dynamic perfusion pattern of arterial hyperenhancement and venous or delayed phase washout is demonstrated. If the imaging characteristics of hepatocellular carcinoma are not met, the alternate modality should be performed. Biopsy should be used if neither modality is diagnostic of hepatocellular carcinoma. Once the diagnosis has been made, the cancer should be assigned a BCLC stage, which will help determine suitable treatment options. Radiologists require a systematic approach to diagnose and stage hepatocellular carcinoma with appropriate accuracy and precision.

Quantification of hepatocellular carcinoma heterogeneity with multiparametric magnetic resonance imaging

“…The mpMRI analysis could rather be used to improve the characterization of HCC lesions in biopsied or resected samples, by providing mutual and additional information on tumour properties on a whole-tumour level 12 . Nevertheless, in the majority of patients HCC is diagnosed based on imaging alone, without histologic confirmation 55 . Treatment stratification in those patients without biopsy could ultimately benefit from knowledge of the correlation of imaging parameters with histopathological and genomics properties of HCC lesions in a training set of resected HCC samples.…”

Advanced-stage hepatocellular carcinoma with portal vein thrombosis: conventional versus drug-eluting beads transcatheter arterial chemoembolization

“…Any ambiguities were resolved by consensus. PVT was defined either by arterial hyper-enhancement and venous or delayed-phase washout or by restricted diffusion within the portal vein on contrast-enhanced MR or CT images that were acquired no earlier than one month prior to the first TACE session [37]. The localization of the vascular invasion was classified as either main PVT if the main portal vein or the confluence of the left and right portal vein was affected, or peripheral PVT if the first and/or second order of the portal vein was involved [34].…”

Myxoid hepatocellular neoplasms: imaging appearance of a unique mucinous tumor variant

“…Our study population did not have any underlying chronic liver disease. The progressive enhancement pattern and marked T2 signal of MHNs differentiate these tumors from conventional HCC [12]. Biphenotypic tumors comprising of hepatocellular carcinoma and cholangiocarcinoma may show progressive central enhancement with peripheral washout [13].…”