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Hepatocellular Carcinoma
Michael P. Federle, MD, FACR
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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 a 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. Gaddikeri S et al: Hepatocellular carcinoma in the noncirrhotic liver. AJR Am J Roentgenol. 203(1):W34-47, 2014
                                            2. 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
                                            3. Roth CG et al: Hepatocellular carcinoma and other hepatic malignancies: MR imaging. Radiol Clin North Am. 52(4):683-707, 2014
                                            4. 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
                                            5. 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
                                            6. 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
                                            7. Sano K et al: Imaging study of early hepatocellular carcinoma: usefulness of gadoxetic acid-enhanced MR imaging. Radiology. 261(3):834-44, 2011
                                            8. Starr SP et al: Cirrhosis: diagnosis, management, and prevention. Am Fam Physician. 84(12):1353-9, 2011
                                            9. 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
                                            10. Vivarelli M et al: Liver transplantation for hepatocellular carcinoma on cirrhosis: strategies to avoid tumor recurrence. World J Gastroenterol. 17(43):4741-6, 2011
                                            11. 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
                                            12. 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
                                            13. Willatt JM et al: MR Imaging of hepatocellular carcinoma in the cirrhotic liver: challenges and controversies. Radiology. 247(2):311-30, 2008
                                            14. Laghi A et al: Hepatocellular carcinoma: detection with triple-phase multi-detector row helical CT in patients with chronic hepatitis. Radiology. 226(2):543-9, 2003
                                            15. Brancatelli G et al: Hepatocellular carcinoma in noncirrhotic liver: CT, clinical, and pathologic findings in 39 U.S. residents. Radiology. 222(1):89-94, 2002
                                            16. Kim T et al: Discrimination of small hepatic hemangiomas from hypervascular malignant tumors smaller than 3 cm with three-phase helical CT. Radiology. 219(3):699-706, 2001
                                            17. Murakami T et al: Hypervascular hepatocellular carcinoma: detection with double arterial phase multi-detector row helical CT. Radiology. 218(3):763-7, 2001
                                            18. Peterson MS et al: Pretransplantation surveillance for possible hepatocellular carcinoma in patients with cirrhosis: epidemiology and CT-based tumor detection rate in 430 cases with surgical pathologic correlation. Radiology. 217(3):743-9, 2000
                                            19. Oliver JH 3rd et al: Detecting hepatocellular carcinoma: value of unenhanced or arterial phase CT imaging or both used in conjunction with conventional portal venous phase contrast-enhanced CT imaging. AJR Am J Roentgenol. 167(1):71-7, 1996
                                            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 a 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. Gaddikeri S et al: Hepatocellular carcinoma in the noncirrhotic liver. AJR Am J Roentgenol. 203(1):W34-47, 2014
                                                                                      2. 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
                                                                                      3. Roth CG et al: Hepatocellular carcinoma and other hepatic malignancies: MR imaging. Radiol Clin North Am. 52(4):683-707, 2014
                                                                                      4. 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
                                                                                      5. 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
                                                                                      6. 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
                                                                                      7. Sano K et al: Imaging study of early hepatocellular carcinoma: usefulness of gadoxetic acid-enhanced MR imaging. Radiology. 261(3):834-44, 2011
                                                                                      8. Starr SP et al: Cirrhosis: diagnosis, management, and prevention. Am Fam Physician. 84(12):1353-9, 2011
                                                                                      9. 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
                                                                                      10. Vivarelli M et al: Liver transplantation for hepatocellular carcinoma on cirrhosis: strategies to avoid tumor recurrence. World J Gastroenterol. 17(43):4741-6, 2011
                                                                                      11. 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
                                                                                      12. 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
                                                                                      13. Willatt JM et al: MR Imaging of hepatocellular carcinoma in the cirrhotic liver: challenges and controversies. Radiology. 247(2):311-30, 2008
                                                                                      14. Laghi A et al: Hepatocellular carcinoma: detection with triple-phase multi-detector row helical CT in patients with chronic hepatitis. Radiology. 226(2):543-9, 2003
                                                                                      15. Brancatelli G et al: Hepatocellular carcinoma in noncirrhotic liver: CT, clinical, and pathologic findings in 39 U.S. residents. Radiology. 222(1):89-94, 2002
                                                                                      16. Kim T et al: Discrimination of small hepatic hemangiomas from hypervascular malignant tumors smaller than 3 cm with three-phase helical CT. Radiology. 219(3):699-706, 2001
                                                                                      17. Murakami T et al: Hypervascular hepatocellular carcinoma: detection with double arterial phase multi-detector row helical CT. Radiology. 218(3):763-7, 2001
                                                                                      18. Peterson MS et al: Pretransplantation surveillance for possible hepatocellular carcinoma in patients with cirrhosis: epidemiology and CT-based tumor detection rate in 430 cases with surgical pathologic correlation. Radiology. 217(3):743-9, 2000
                                                                                      19. Oliver JH 3rd et al: Detecting hepatocellular carcinoma: value of unenhanced or arterial phase CT imaging or both used in conjunction with conventional portal venous phase contrast-enhanced CT imaging. AJR Am J Roentgenol. 167(1):71-7, 1996