Imaging of HCC—Current State of the Art

Abstract

Early diagnosis of hepatocellular carcinoma (HCC) is crucial for optimizing treatment outcome. Ongoing advances are being made in imaging of HCC regarding detection, grading, staging, and also treatment monitoring. This review gives an overview of the current international guidelines for diagnosing HCC and their discrepancies as well as critically summarizes the role of magnetic resonance imaging (MRI) and computed tomography (CT) techniques for imaging in HCC. The diagnostic performance of MRI with nonspecific and hepatobililiary contrast agents and the role of functional imaging with diffusion-weighted imaging will be discussed. On the other hand, CT as a fast, cheap and easily accessible imaging modality plays a major role in the clinical routine work-up of HCC. Technical advances in CT, such as dual energy CT and volume perfusion CT, are currently being explored for improving detection, characterization and staging of HCC with promising results. Cone beam CT can provide a three-dimensional analysis of the liver with tumor and vessel characterization comparable to cross-sectional imaging so that this technique is gaining an increasing role in the peri-procedural imaging of HCC treated with interventional techniques.

Evaluation of antiangiogenic and antiproliferative effects of sorafenib by sequential histology and intravoxel incoherent motion diffusion-weighted imaging in an orthotopic hepatocellular carcinoma xenograft model

“…And its use frequently causes side effects and is costly . An imaging technology being able to determine the therapeutic efficacy of sorafenib at an early stage is desirable because it helps in selecting responsive patients to sorafenib shortly after the start of treatment . It may also enable a better understanding of the changes of HCC neoangiogenesis and proliferation during sorafenib treatment, which are incompletely understood.…”

Gadoxetic Acid–enhanced Magnetic Resonance Imaging and Contrast-enhanced Ultrasonography in the Diagnosis of Hepatocellular Carcinoma

“…Gadoxetic acid possesses dual properties by providing information on both the vascular phase (during dynamic contrast enhancement) and hepatobiliary phase (HBP). 14 It has a higher affinity for protein binding and therefore an increased signal intensity during enhancement. While normal liver parenchyma progressively enhances due to the hepatocyte uptake of gadoxetic acid, most HCCs appear hypointense on the HBP.…”

Übersicht – Hepatozelluläres Karzinom: Screening und Diagnostik

“…Kontrovers diskutiert wird dagegen die Bedeutung des Kontrastultraschalls, denn dieser ist mit gewissen Nachteilen behaftet. Aufgrund der Beschaffenheit des Kontrastmittels auf der Basis von Mikrobläschen verbleibt das Kontrastmittel ausschließlich im intravaskulären Raum, was beispielsweise beim intrahepatischen Cholangiozellulären Karzinom zu Abgrenzungsschwierigkeiten gegenüber dem HCC führen kann [27]. Der kontrastverstärkte Ultraschall wird daher in keiner der westlichen Leitlinien für die Diagnostik des HCC empfohlen.…”