Hepatocellular Carcinoma: State of the Art Imaging and Recent Advances

Abstract

The incidence of hepatocellular carcinoma (HCC) is increasing, with this trend expected to continue to the year 2030. Hepatocarcinogenesis follows a predictable course, which makes adequate identification and surveillance of at-risk individuals central to a successful outcome. Moreover, imaging is central to this surveillance, and ultimately to diagnosis and management. Many liver study groups throughout Asia, North America and Europe advocate a surveillance program for at-risk individuals to allow early identification of HCC. Ultrasound is the most commonly utilized imaging modality. Many societies offer guidelines on how to diagnose HCC. The Liver Image Reporting and Data System (LIRADS) was introduced to standardize the acquisition, interpretation, reporting and data collection of HCC cases. The LIRADS advocates diagnosis using multiphase computed tomography or magnetic resonance imaging (MRI) imaging. The 2017 version also introduces contrast-enhanced ultrasound as a novel approach to diagnosis. Indeed, imaging techniques have evolved to improve diagnostic accuracy and characterization of HCC lesions. Newer techniques, such as T1 mapping, intravoxel incoherent motion analysis and textural analysis, assess specific characteristics that may help grade the tumor and guide management, allowing for a more personalized approach to patient care. This review aims to analyze the utility of imaging in the surveillance and diagnosis of HCC and to assess novel techniques which may increase the accuracy of imaging and determine optimal treatment strategies.

Virtual monoenergetic images from spectral detector computed tomography facilitate washout assessment in arterially hyper-enhancing liver lesions

“…Typical radiological findings in HCC include a combination of an arterial hyper-enhancement (APHE) with nonperipheral washout in portal-venous and/or delayed phase in CT/MRI or late washout (> 60s) in CEUS, enhancing capsule and/or lesion threshold growth on a follow-up scan [2,5,6]. The assessment of washout, defined as a hypointensity, hypo-density or hypoechogenicity compared to the adjacent liver parenchyma, can be difficult in cases with only subtle differences [7].…”

Advances in early diagnosis of hepatocellular carcinoma

“…In the case of non-cirrhotic patients vascular profiling of the liver tumor on imaging studies reveals no consistent clue for HCC, a biopsy of the lesion is recommended to rule out HCC. According to the recommendations of the Asia-Pacific Association for the Study of the Liver 2010, every nodular lesion with uncharacteristic vascular profiles should undergo further imaging investigation such as endoscopic ultrasonography (EUS) as the confirmation for HCC [8] . Contrast enhanced CT and MRI scans are most efficient in differentiate and analyze diverse liver nodules and can characterize late stage HCC by its exclusive appearance of arterialphase hypervascularity, however, this feature often lacks in early HCC [9,10] .…”

“…Technically, AFP-L3 is a glycoform of AFP that exclusively originates from cancer cells and demonstrates higher specificity for HCC in combination with AFP [14] . However, AFP-L3 is not typically detected when AFP levels are < 20 ng/mL [8] and it has a low sensitivity for early stage HCC diagnosis.…”

Circulating MicroRNA-122 for the Diagnosis of Hepatocellular Carcinoma: A Meta-Analysis

“…Currently, clinical screening strategies for HCC mainly involve ultrasonography [3,4]. However, the diagnostic performance of ultrasonography for early HCC is poor due to its low sensitivity [5].…”

“…However, the diagnostic performance of ultrasonography for early HCC is poor due to its low sensitivity [5]. Other imaging modalities such as computer tomography (CT) and magnetic resonance imaging (MRI) have limited value for HCC screening because of the risk of radiation exposure or high expense [3,4]. Serum biomarkers may be convenient and effective for early diagnosis of HCC.…”