Imaging diagnosis of hepatocellular carcinoma: Future directions with special emphasis on hepatobiliary magnetic resonance imaging and contrast-enhanced ultrasound

Abstract

Hepatocellular carcinoma (HCC) is a unique cancer entity that can be noninvasively diagnosed using imaging modalities without pathologic confirmation. In 2018, several major guidelines for HCC were updated to include hepatobiliary contrast agent magnetic resonance imaging (HBA-MRI) and contrast-enhanced ultrasound (CEUS) as major imaging modalities for HCC diagnosis. HBA-MRI enables the achievement of high sensitivity in HCC detection using the hepatobiliary phase (HBP). CEUS is another imaging modality with real-time imaging capability, and it is reported to be useful as a second-line modality to increase sensitivity without losing specificity for HCC diagnosis. However, until now, there is an unsolved discrepancy among guidelines on whether to accept “HBP hypointensity” as a definite diagnostic criterion for HCC or include CEUS in the diagnostic algorithm for HCC diagnosis. Furthermore, there is variability in terminology and inconsistencies in the definition of imaging findings among guidelines; therefore, there is an unmet need for the development of a standardized lexicon. In this article, we review the performance and limitations of HBA-MRI and CEUS after guideline updates in 2018 and briefly introduce some future aspects of imaging-based HCC diagnosis.

The clinical effect of antiviral therapy in patients with hepatitis B virus‐related decompensated cirrhosis and undetectable DNA

“…Secondary outcomes were HCC development and HBV‐DNA detection. HCC was diagnosed based on histological evidence, dynamic computed tomography, and/or magnetic resonance imaging findings (a nodule > 1 cm with arterial hypervascularity and portal/delayed‐phase washout) 21,22 …”

“…HCC was diagnosed based on histological evidence, dynamic computed tomography, and/or magnetic resonance imaging findings (a nodule > 1 cm with arterial hypervascularity and portal/delayedphase washout). 21,22 Statistical analysis. To compare the different variables between groups, continuous variables were analyzed using the Student's t-test or the Mann-Whitney U-test, and categorical variables were analyzed using the χ 2 test or the Fisher exact test when appropriate.…”

Clinical practice guidelines and real-life practice in hepatocellular carcinoma: A Chinese perspective

“…Therefore, confirmation via two imaging techniques for nodules of 1-2cm continues to be adopted in China. EOB-MRI and CEUS have been included as diagnostic modalities to increase diagnostic sensitivity in China since 2017 [20].…”

Clinical practice guideline and real-life practice in hepatocellular carcinoma: A Korean perspective

“…1 The allowance of washout appearance in hepatobiliary phases in the non-invasive imaging diagnosis of HCC was a major change of radiological hallmarks in 2018 KLCA-NCC guidelines. 6,19 Since then, several studies have compared the diagnostic performance of 2018 KLCA-NCC practice guidelines to that of the Liver Imaging-Reporting and Data System (LI-RADS) and found higher sensitivity without a reduction in specificity when MRI with liverspecific contrast is used. [20][21][22] Hence, the updated 2022 KLCA-NCC guidelines kept the noninvasive diagnosis criteria of the 2018 KLCA-NCC guidelines when using MRI with liverspecific contrast.…”