MRI of hepatocellular carcinoma: an update of current practices

Abstract

Hepatocellular carcinoma (HCC) is one of the most common cancers worldwide, and liver transplantation is the optimal treatment for selected patients with HCC and chronic liver disease (CLD). Accurate selection of patients for transplantation is essential to maximize patient outcomes and ensure optimized allocation of donor organs. Magnetic resonance imaging (MRI) is a powerful tool for the detection, characterization, and staging of HCC. In patients with CLD, the MRI findings of an arterial-enhancing mass with subsequent washout and enhancing capsule on delayed interstitial phase images are diagnostic for HCC. Major organizations with oversight for organ donor distribution, such as The Organ Procurement and Transplantation Network (OPTN), accept an imaging diagnosis of HCC, no longer requiring tissue biopsy. In patients that are awaiting transplantation, or are not candidates for liver transplantation, localized therapies such as transarterial chemoembolization and radiofrequency ablation may be offered. MRI can be used to monitor treatment response. The purpose of this review article is to describe the role of imaging methods in the diagnosis, staging, and follow-up of HCC, with particular emphasis on established and evolving MRI techniques employing nonspecific gadolinium chelates, hepatobiliary contrast agents, and diffusion weighted imaging. We also briefly review the recently developed Liver Imaging Reporting and Data System (LI-RADS) formulating a standardized terminology and reporting structure for evaluation of lesions detected in patients with CLD.H epatocellular carcinoma (HCC) is a major worldwide health concern; it is the sixth most common cancer and third leading cause of overall cancer-related mortality. HCC frequently presents as a rapidly growing tumor and has historically been associated with poor prognosis and outcomes. However, tumor screening protocols in high risk patients can lead to an earlier detection of treatable disease. Screening for HCC has resulted in significant improvements in the one-year cause-specific survival rates for new patients (1), and this is directly attributed to improved survival through the detection of early stage tumor.The five-year cumulative risk of HCC ranges from 4%-30% in patients with chronic liver disease (CLD) and cirrhosis (2-3). Multiple therapeutic strategies are available for the treatment of HCC, including medical therapy, percutaneous tumor ablation, transarterial embolic therapy, surgical resection, and liver transplantation. Of all the available methods, liver transplantation is the most effective treatment for early HCC because this method removes not only the tumor but also the entire cirrhotic liver, which is at an increased risk for developing metachronous tumors. The effectiveness of liver transplantation depends upon detecting early stage disease within specific criteria. A seminal paper by Mazzaferro et al. (4), published in 1996, established the "Milan criteria" as the most widely used guidelines for transplant eligibility. The Mila...

Intrahepatic recurrence of single nodular hepatocellular carcinoma after surgical resection: an analysis by segmental distribution

“…Radiologic diagnoses of HCC recurrence and localization were performed using computed tomography or magnetic resonance imaging findings . When a tumour was located across two or more Couinaud's segments, the location of the tumour centre was defined as the representative location.…”

2014 KLCSG-NCC Korea Practice Guidelines for the Management of Hepatocellular Carcinoma: HCC Diagnostic Algorithm

“…There are several ancillary imaging features which are frequently identified in progressed HCC and therefore reported as suggestive signs of HCC [16,101,102,103,104]. These include mild to moderate signal intensity in the T2-weighted image, intralesional fat, iron sparing in an iron-overloaded liver, corona enhancement, nodule-in-nodule or ‘mosaic' appearance, capsule appearance or pseudocapsule at equilibrium phase imaging, low signal intensity in the hepatobiliary phase of gadoxetic acid-enhanced MRI and high signal intensity in diffusion-weighted imaging (DWI), suggesting restricted or impeded diffusion [16,104].…”

Fluorescent peptide highlights micronodules in murine hepatocellular carcinoma models and humans in vitro

“…Recently, advances in imaging‐based diagnostic modalities such as computed tomography, ultrasound, positron‐emission tomography, and magnetic resonance imaging have made it possible to detect HCC nodules with a diameter of 2 cm accurately. Importantly, the detection of small lesions with a diameter of 0.5‐1 cm becomes possible with improved magnetic resonance imaging techniques . However, a major limitation to these techniques is their limited spatial resolution and the difficulty of converting two‐dimensional information to the three‐dimensional clinical practice for guiding surgery.…”

“…resonance imaging techniques. (6)(7)(8)(9) However, a major limitation to these techniques is their limited spatial resolution and the difficulty of converting twodimensional information to the three-dimensional clinical practice for guiding surgery. Moreover, it remains challenging to identify and delineate micronodules with diameters <0.5 cm with current imaging approaches.…”