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Gastrointestinal
Diagnosis
Liver
Malignant Neoplasms
Hepatocellular Carcinoma
Hepatocellular Carcinoma
Atif Zaheer, MD
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KEY FACTS

  • Imaging

    • Top Differential Diagnoses

      • Clinical Issues

        TERMINOLOGY

        • Abbreviations

          • Hepatocellular carcinoma (HCC)

        • Synonyms

          • Hepatoma, primary liver cancer

        • Definitions

          • Most common primary malignant liver tumor, usually arising in cirrhotic liver

        IMAGING

        • General Features

          • CT Findings

            • MR Findings

              • Ultrasonographic Findings

                • Angiographic Findings

                  • Nuclear Medicine Findings

                    • Imaging Recommendations

                      DIFFERENTIAL DIAGNOSIS

                        PATHOLOGY

                        • General Features

                          • Gross Pathologic & Surgical Features

                            • Microscopic Features

                              CLINICAL ISSUES

                              • Presentation

                                • Demographics

                                  • Natural History & Prognosis

                                    • Treatment

                                      • Surveillance for HCC

                                        DIAGNOSTIC CHECKLIST

                                        • Image Interpretation Pearls

                                          • Reporting Tips

                                            Selected References

                                            1. Ricke J et al: Gadoxetic acid-based hepatobiliary MRI in hepatocellular carcinoma. JHEP Rep. 2(6):100173, 2020
                                            2. Elsayes KM et al: User and system pitfalls in liver imaging with LI-RADS. J Magn Reson Imaging. 50(6):1673-86, 2019
                                            3. Hsiao CY et al: A prospective assessment of the diagnostic value of contrast-enhanced ultrasound, dynamic computed tomography and magnetic resonance imaging for patients with small liver tumors. J Clin Med. 8(9), 2019
                                            4. Kim JH et al: Atypical appearance of hepatocellular carcinoma and its mimickers: how to solve challenging cases using gadoxetic acid-enhanced liver magnetic resonance imaging. Korean J Radiol. 20(7):1019-41, 2019
                                            5. Rodgers SK et al: Role of US LI-RADS in the LI-RADS algorithm. Radiographics. 39(3):690-708, 2019
                                            6. Villanueva A: Hepatocellular carcinoma. N Engl J Med. 380(15):1450-62, 2019
                                            7. Chernyak V et al: Liver Imaging Reporting and Data System (LI-RADS) version 2018: imaging of hepatocellular carcinoma in at-risk patients. Radiology. 289(3):816-30, 2018
                                            8. Choi YR et al: Diagnostic accuracy of contrast-enhanced dynamic CT for small hypervascular hepatocellular carcinoma and assessment of dynamic enhancement patterns: results of two-year follow-up using cone-beam CT hepatic arteriography. PLoS One. 13(9):e0203940, 2018
                                            9. Horvat N et al: State of the art in magnetic resonance imaging of hepatocellular carcinoma. Radiol Oncol. 52(4):353-64, 2018
                                            10. Elsayes KM et al: Liver Imaging Reporting and Data System: an expert consensus statement. J Hepatocell Carcinoma. 4:29-39, 2017
                                            11. Hoogenboom TC et al: Functional imaging of hepatocellular carcinoma. Hepat Oncol. 3(2):137-53, 2016
                                            12. Reynolds AR et al: Infiltrative hepatocellular carcinoma: what radiologists need to know. Radiographics. 35(2):371-86, 2015
                                            13. Gaddikeri S et al: Hepatocellular carcinoma in the noncirrhotic liver. AJR Am J Roentgenol. 203(1):W34-47, 2014
                                            14. Jha RC et al: LI-RADS categorization of benign and likely benign findings in patients at risk of hepatocellular carcinoma: a pictorial atlas. AJR Am J Roentgenol. 203(1):W48-69, 2014
                                            15. Roth CG et al: Hepatocellular carcinoma and other hepatic malignancies: MR imaging. Radiol Clin North Am. 52(4):683-707, 2014
                                            16. Gonzalez SA et al: Risk assessment for hepatocellular carcinoma in chronic hepatitis B: scores and surveillance. Int J Clin Pract. 66(1):7-10, 2012
                                            17. Becker-Weidman DJ et al: Hepatocellular carcinoma lesion characterization: single-institution clinical performance review of multiphase gadolinium-enhanced MR imaging--comparison to prior same-center results after MR systems improvements. Radiology. 261(3):824-33, 2011
                                            18. Haradome H et al: Additional value of gadoxetic acid-DTPA-enhanced hepatobiliary phase MR imaging in the diagnosis of early-stage hepatocellular carcinoma: comparison with dynamic triple-phase multidetector CT imaging. J Magn Reson Imaging. 34(1):69-78, 2011
                                            19. Sano K et al: Imaging study of early hepatocellular carcinoma: usefulness of gadoxetic acid-enhanced MR imaging. Radiology. 261(3):834-44, 2011
                                            20. Suh YJ et al: Differentiation of hepatic hyperintense lesions seen on gadoxetic acid-enhanced hepatobiliary phase MRI. AJR Am J Roentgenol. 197(1):W44-52, 2011
                                            21. Vivarelli M et al: Liver transplantation for hepatocellular carcinoma on cirrhosis: strategies to avoid tumor recurrence. World J Gastroenterol. 17(43):4741-6, 2011
                                            22. Yu JS et al: Detection of small intrahepatic metastases of hepatocellular carcinomas using diffusion-weighted imaging: comparison with conventional dynamic MRI. Magn Reson Imaging. 29(7):985-92, 2011
                                            23. Hanna RF et al: Double-contrast MRI for accurate staging of hepatocellular carcinoma in patients with cirrhosis. AJR Am J Roentgenol. 190(1):47-57, 2008
                                            24. Willatt JM et al: MR Imaging of hepatocellular carcinoma in the cirrhotic liver: challenges and controversies. Radiology. 247(2):311-30, 2008
                                            Related Anatomy
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                                            Related Differential Diagnoses
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                                            References
                                            Tables

                                            Tables

                                            KEY FACTS

                                            • Imaging

                                              • Top Differential Diagnoses

                                                • Clinical Issues

                                                  TERMINOLOGY

                                                  • Abbreviations

                                                    • Hepatocellular carcinoma (HCC)

                                                  • Synonyms

                                                    • Hepatoma, primary liver cancer

                                                  • Definitions

                                                    • Most common primary malignant liver tumor, usually arising in cirrhotic liver

                                                  IMAGING

                                                  • General Features

                                                    • CT Findings

                                                      • MR Findings

                                                        • Ultrasonographic Findings

                                                          • Angiographic Findings

                                                            • Nuclear Medicine Findings

                                                              • Imaging Recommendations

                                                                DIFFERENTIAL DIAGNOSIS

                                                                  PATHOLOGY

                                                                  • General Features

                                                                    • Gross Pathologic & Surgical Features

                                                                      • Microscopic Features

                                                                        CLINICAL ISSUES

                                                                        • Presentation

                                                                          • Demographics

                                                                            • Natural History & Prognosis

                                                                              • Treatment

                                                                                • Surveillance for HCC

                                                                                  DIAGNOSTIC CHECKLIST

                                                                                  • Image Interpretation Pearls

                                                                                    • Reporting Tips

                                                                                      Selected References

                                                                                      1. Ricke J et al: Gadoxetic acid-based hepatobiliary MRI in hepatocellular carcinoma. JHEP Rep. 2(6):100173, 2020
                                                                                      2. Elsayes KM et al: User and system pitfalls in liver imaging with LI-RADS. J Magn Reson Imaging. 50(6):1673-86, 2019
                                                                                      3. Hsiao CY et al: A prospective assessment of the diagnostic value of contrast-enhanced ultrasound, dynamic computed tomography and magnetic resonance imaging for patients with small liver tumors. J Clin Med. 8(9), 2019
                                                                                      4. Kim JH et al: Atypical appearance of hepatocellular carcinoma and its mimickers: how to solve challenging cases using gadoxetic acid-enhanced liver magnetic resonance imaging. Korean J Radiol. 20(7):1019-41, 2019
                                                                                      5. Rodgers SK et al: Role of US LI-RADS in the LI-RADS algorithm. Radiographics. 39(3):690-708, 2019
                                                                                      6. Villanueva A: Hepatocellular carcinoma. N Engl J Med. 380(15):1450-62, 2019
                                                                                      7. Chernyak V et al: Liver Imaging Reporting and Data System (LI-RADS) version 2018: imaging of hepatocellular carcinoma in at-risk patients. Radiology. 289(3):816-30, 2018
                                                                                      8. Choi YR et al: Diagnostic accuracy of contrast-enhanced dynamic CT for small hypervascular hepatocellular carcinoma and assessment of dynamic enhancement patterns: results of two-year follow-up using cone-beam CT hepatic arteriography. PLoS One. 13(9):e0203940, 2018
                                                                                      9. Horvat N et al: State of the art in magnetic resonance imaging of hepatocellular carcinoma. Radiol Oncol. 52(4):353-64, 2018
                                                                                      10. Elsayes KM et al: Liver Imaging Reporting and Data System: an expert consensus statement. J Hepatocell Carcinoma. 4:29-39, 2017
                                                                                      11. Hoogenboom TC et al: Functional imaging of hepatocellular carcinoma. Hepat Oncol. 3(2):137-53, 2016
                                                                                      12. Reynolds AR et al: Infiltrative hepatocellular carcinoma: what radiologists need to know. Radiographics. 35(2):371-86, 2015
                                                                                      13. Gaddikeri S et al: Hepatocellular carcinoma in the noncirrhotic liver. AJR Am J Roentgenol. 203(1):W34-47, 2014
                                                                                      14. Jha RC et al: LI-RADS categorization of benign and likely benign findings in patients at risk of hepatocellular carcinoma: a pictorial atlas. AJR Am J Roentgenol. 203(1):W48-69, 2014
                                                                                      15. Roth CG et al: Hepatocellular carcinoma and other hepatic malignancies: MR imaging. Radiol Clin North Am. 52(4):683-707, 2014
                                                                                      16. Gonzalez SA et al: Risk assessment for hepatocellular carcinoma in chronic hepatitis B: scores and surveillance. Int J Clin Pract. 66(1):7-10, 2012
                                                                                      17. Becker-Weidman DJ et al: Hepatocellular carcinoma lesion characterization: single-institution clinical performance review of multiphase gadolinium-enhanced MR imaging--comparison to prior same-center results after MR systems improvements. Radiology. 261(3):824-33, 2011
                                                                                      18. Haradome H et al: Additional value of gadoxetic acid-DTPA-enhanced hepatobiliary phase MR imaging in the diagnosis of early-stage hepatocellular carcinoma: comparison with dynamic triple-phase multidetector CT imaging. J Magn Reson Imaging. 34(1):69-78, 2011
                                                                                      19. Sano K et al: Imaging study of early hepatocellular carcinoma: usefulness of gadoxetic acid-enhanced MR imaging. Radiology. 261(3):834-44, 2011
                                                                                      20. Suh YJ et al: Differentiation of hepatic hyperintense lesions seen on gadoxetic acid-enhanced hepatobiliary phase MRI. AJR Am J Roentgenol. 197(1):W44-52, 2011
                                                                                      21. Vivarelli M et al: Liver transplantation for hepatocellular carcinoma on cirrhosis: strategies to avoid tumor recurrence. World J Gastroenterol. 17(43):4741-6, 2011
                                                                                      22. Yu JS et al: Detection of small intrahepatic metastases of hepatocellular carcinomas using diffusion-weighted imaging: comparison with conventional dynamic MRI. Magn Reson Imaging. 29(7):985-92, 2011
                                                                                      23. Hanna RF et al: Double-contrast MRI for accurate staging of hepatocellular carcinoma in patients with cirrhosis. AJR Am J Roentgenol. 190(1):47-57, 2008
                                                                                      24. Willatt JM et al: MR Imaging of hepatocellular carcinoma in the cirrhotic liver: challenges and controversies. Radiology. 247(2):311-30, 2008