Published online Jun 21, 2018. doi: 10.3748/wjg.v24.i23.2413
Peer-review started: March 28, 2018
First decision: April 19, 2018
Revised: April 27, 2018
Accepted: May 11, 2018
Article in press: May 11, 2018
Published online: June 21, 2018
Magnetic resonance (MR) imaging of the liver is an important tool for the detection and characterization of focal liver lesions and for assessment of diffuse liver disease, having several intrinsic characteristics, represented by high soft tissue contrast, avoidance of ionizing radiation or iodinated contrast media, and more recently, by application of several functional imaging techniques (i.e., diffusion-weighted sequences, hepatobiliary contrast agents, perfusion imaging, magnetic resonance (MR)-elastography, and radiomics analysis). MR functional imaging techniques are extensively used both in routine practice and in the field of clinical and pre-clinical research because, through a qualitative rather than quantitative approach, they can offer valuable information about tumor tissue and tissue architecture, cellular biomarkers related to the hepatocellular functions, or tissue vascularization profiles related to tumor and tissue biology. This kind of approach offers in vivo physiological parameters, capable of evaluating physiological and pathological modifications of tissues, by the analysis of quantitative data that could be used in tumor detection, characterization, treatment selection, and follow-up, in addition to those obtained from standard morphological imaging. In this review we provide an overview of recent advanced techniques in MR for the diagnosis and staging of hepatocellular carcinoma, and their role in the assessment of response treatment evaluation.
Core tip: Magnetic resonance (MR) of the liver is an important diagnostic option for detection and characterization of focal liver lesions. To date, beside the standard morphological sequences, new functional imaging tools (i.e., diffusion-weighted sequences, hepatobiliary contrast agents, perfusion imaging, MR-elastography, or radiomics analysis) have been introduced in clinical practice. The aim of functional imaging is to provide in vivo quantitative complementary functional data related to the tissue or tumor modifications, offering useful comprehensive information about the biology, behavior, and prognosis of hepatocellular carcinoma lesions. This functional approach may help clinicians correctly manage cirrhotic patients, also after therapeutic treatment.