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Copyright ©The Author(s) 2016. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastroenterol. Jan 7, 2016; 22(1): 205-220
Published online Jan 7, 2016. doi: 10.3748/wjg.v22.i1.205
Advances in computed tomography and magnetic resonance imaging of hepatocellular carcinoma
Tiffany Hennedige, Sudhakar K Venkatesh
Tiffany Hennedige, Department of Oncologic Imaging, National Cancer Centre, Singapore 169610, Singapore
Sudhakar K Venkatesh, Department of Radiology, Mayo Clinic, MN 55905, United States
Author contributions: Hennedige T and Venkatesh SK analyzed the literature and wrote the manuscript.
Conflict-of-interest statement: The authors have no conflict of interest to report.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Sudhakar K Venkatesh, MD, FRCR, Department of Radiology, Mayo Clinic, 200, First Street SW, Rochester, MN 55905, United States. venkatesh.sudhakar@mayo.edu
Telephone: +1-507-2841728 Fax: +1-507-2842405
Received: May 29, 2015
Peer-review started: June 1, 2015
First decision: July 14, 2015
Revised: August 4, 2015
Accepted: December 1, 2015
Article in press: December 1, 2015
Published online: January 7, 2016
Abstract

Hepatocellular carcinoma (HCC) is the most common primary liver cancer. Imaging is important for establishing a diagnosis of HCC and early diagnosis is imperative as several potentially curative treatments are available when HCC is small. Hepatocarcinogenesis occurs in a stepwise manner on a background of chronic liver disease or cirrhosis wherein multiple genes are altered resulting in a range of cirrhosis-associated nodules. This progression is related to increased cellularity, neovascularity and size of the nodule. An understanding of the stepwise progression may aid in early diagnosis. Dynamic and multiphase contrast-enhanced computed tomography and magnetic resonance imaging still form the cornerstone in the diagnosis of HCC. An overview of the current diagnostic standards of HCC in accordance to the more common practicing guidelines and their differences will be reviewed. Ancillary features contribute to diagnostic confidence and has been incorporated into the more recent Liver Imaging Reporting and Data System. The use of hepatocyte-specific contrast agents is increasing and gradually changing the standard of diagnosis of HCC; the most significant benefit being the lack of uptake in the hepatocyte phase in the earlier stages of HCC progression. An outline of supplementary techniques in the imaging of HCC will also be reviewed.

Keywords: Hepatocellular carcinoma, Computed tomography, Magnetic resonance imaging, Contrast agent, Cirrhosis, Ancillary features

Core tip: Imaging is important for establishing a diagnosis of hepatocellular carcinoma (HCC) and an understanding of the stepwise progression of hepatocarcinogenesis may aid in early diagnosis. Dynamic and multiphase contrast-enhanced computed tomography and magnetic resonance imaging still form the cornerstone in the diagnosis of HCC. An overview of the current diagnostic standards of HCC in accordance to the more common practicing guidelines and their differences will be reviewed. Various ancillary features, use of hepatocyte-specific contrast agents and supplementary imaging techniques also help to increase diagnostic confidence and will be reviewed.