Copyright ©The Author(s) 2018. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastroenterol. Jun 21, 2018; 24(23): 2413-2426
Published online Jun 21, 2018. doi: 10.3748/wjg.v24.i23.2413
Recent advances in non-invasive magnetic resonance imaging assessment of hepatocellular carcinoma
Davide Ippolito, Riccardo Inchingolo, Luigi Grazioli, Silvia Girolama Drago, Michele Nardella, Marco Gatti, Riccardo Faletti
Davide Ippolito, Silvia Girolama Drago, School of Medicine, University of Milano-Bicocca, Milan 20126, Italy
Davide Ippolito, Silvia Girolama Drago, Department of Diagnostic Radiology, HS Gerardo Monza, Monza (MB) 20900, Italy
Riccardo Inchingolo, Michele Nardella, Division of Interventional Radiology, Department of Radiology, Madonna delle Grazie Hospital, Matera 75100, Italy
Luigi Grazioli, Department of Radiology, University of Brescia “Spedali Civili”, Brescia 25123, Italy
Marco Gatti, Riccardo Faletti, Department of Surgical Sciences, Radiology Unit, University of Turin, Turin 10126, Italy
Author contributions: All authors equally contributed to this paper with conception and design of the study, literature review and analysis, drafting and critical revision and editing, and final approval of the final version.
Conflict-of-interest statement: All the authors are aware of the content of the manuscript and have no conflict of interest.
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:
Correspondence to: Davide Ippolito, MD, Adjunct Professor, Staff Physician, Department of Diagnostic Radiology, San Gerardo Hospital, University of Milano-Bicocca, Via Pergolesi 33, Monza (MB) 20900, Italy.
Telephone: +39-2-64488265 Fax: +39-2-64488299
Received: March 26, 2018
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.

Keywords: Liver, Cirrhosis, Hepatocellular carcinoma, Magnetic resonance, Transarterial chemoembolization, Contrast media

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.