Imaging of hepatocellular carcinoma and image guided therapies - how we do it

Abstract

Treatment options for hepatocellular carcinoma have evolved over recent years. Interventional radiologists and surgeons can offer curative treatments for early stage tumours, and locoregional therapies can be provided resulting in longer survival times. Early diagnosis with screening ultrasound is the key. CT and MRI are used to characterize lesions and determine the extent of tumour burden. Imaging techniques are discussed in this article as the correct imaging protocols are essential to optimise successful detection and characterisation. After treatment it is important to establish regular imaging follow up with CT or MRI as local residual disease can be easily treated, and recurrence elsewhere in the liver is common.

Imaging of abnormal liver function tests

“…The best imaging tools for detecting and characterizing HCC are multiphasic contrast‐enhanced CT (CECT) or MRI, which are often specific enough to guide therapy without tissue confirmation . HCC typically appears as heterogenous, hypervascular mass(es) on hepatic arterial phase with washout of contrast enhancement on delayed phase, with or without a pseudocapsule . US has a lower sensitivity and specificity than CT/MRI and is predominantly used as a screening tool in high‐risk patients …”

“…HCC typically appears as heterogenous, hypervascular mass(es) on hepatic arterial phase with washout of contrast enhancement on delayed phase, with or without a pseudocapsule . US has a lower sensitivity and specificity than CT/MRI and is predominantly used as a screening tool in high‐risk patients …”

“…10 HCC typically appears as heterogenous, hypervascular mass(es) on hepatic arterial phase with washout of contrast enhancement on delayed phase, with or without a pseudocapsule. 10,11 US has a lower sensitivity and specificity than CT/MRI and is predominantly used as a screening tool in high-risk patients. 10 In sarcoidosis, NECT may show scattered intrahepatic and intrasplenic hypoattenuating lesions that rapidly isoattenuate after contrast administration.…”

“…10,11 US has a lower sensitivity and specificity than CT/MRI and is predominantly used as a screening tool in high-risk patients. 10 In sarcoidosis, NECT may show scattered intrahepatic and intrasplenic hypoattenuating lesions that rapidly isoattenuate after contrast administration. MRI shows the granulomas as hypointense intrahepatic and intrasplenic nodules on T 1 and T 2 .…”

Patient-specific three-dimensional printing for pre-surgical planning in hepatocellular carcinoma treatment

“…Diagnostic imaging plays a major role in the diagnosis and characterisation of liver lesions, with imaging appearance and radiological reporting outcomes being utilized to direct patient-specific treatment planning (7,8). However, confidence in the comprehension of anatomical, pathological and structural complexities which surgeons require to conduct hepatic resections, may not always be supported by two-dimensional (2D) imaging alone (2).…”