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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): 284-299
Published online Jan 7, 2016. doi: 10.3748/wjg.v22.i1.284
Differentiation of hepatocellular carcinoma from its various mimickers in liver magnetic resonance imaging: What are the tips when using hepatocyte-specific agents?
Yang Shin Park, Chang Hee Lee, Jeong Woo Kim, Sora Shin, Cheol Min Park
Yang Shin Park, Chang Hee Lee, Jeong Woo Kim, Cheol Min Park, Department of Radiology, Korea University Guro Hospital, Korea University College of Medicine, Seoul 152-703, South Korea
Sora Shin, Korea University College of Medicine, Anam-dong 5-ga, Seongbuk-Gu, Seoul 136-701, South Korea
Author contributions: Lee CH designed the study; Park YS wrote the first draft of the manuscript; Park YS, Kim JW and Shin S performed literature research; Lee CH, Kim JW, Shin S, and Park CM gathered image data; Park YS, Lee CH and Park CM were involved in editing the manuscript.
Conflict-of-interest statement: We disclose that all authors have no conflict of interest about this manuscript.
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: Chang Hee Lee, MD, Department of Radiology, Korea University Guro Hospital, Korea University College of Medicine, 80 Guro-dong, Guro-gu, Seoul 152-703, South Korea. chlee86@korea.ac.kr
Telephone: +82-2-26263212 Fax: +82-2-8639282
Received: April 28, 2015
Peer-review started: May 6, 2015
First decision: September 29, 2015
Revised: October 13, 2015
Accepted: November 9, 2015
Article in press: November 9, 2015
Published online: January 7, 2016
Abstract

Hepatocellular carcinoma is the most common primary hepatic malignant tumor. With widespread use of liver imaging, various cirrhosis-related nodules are frequently detected in patients with chronic liver disease, while diverse hypervascular hepatic lesions are incidentally detected but undiagnosed on dynamic computed tomography and magnetic resonance imaging (MRI). However, use of hepatocyte-specific MR contrast agents with combined perfusion and hepatocyte-selective properties have improved diagnostic performance in detection and characterization of focal liver lesions. Meanwhile, the enhancement patterns observed during dynamic phases using hepatocyte-specific agents may be different from those observed during MRI using conventional extracellular fluid agents, leading to confusion in diagnosis. Therefore, we discuss useful tips for the differentiation of hepatocellular carcinoma from similar lesions in patients with and without chronic liver disease using liver MRI with hepatocyte-specific agents.

Keywords: Hepatocellular carcinoma, Gadoxetic acid, Magnetic resonance imaging, Liver cirrhosis

Core tip: Hepatocellular carcinoma is the most common primary hepatic malignant tumor. With widespread use of liver imaging, various cirrhosis-related nodules are more frequently detected in patients with chronic liver disease, while diverse hypervascular hepatic lesions are incidentally detected but undiagnosed on dynamic computed tomography and magnetic resonance imaging (MRI). However, liver MRI using hepatocyte-specific agents has been suggested to be a much more reliable modality in the detection and characterization of focal liver lesions. Therefore, we would like to discuss useful tips for the differentiation of hepatocellular carcinoma from similar lesions in patients with and without chronic liver disease using liver MRI with hepatocyte-specific agents.