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World J Gastroenterol. Dec 14, 2018; 24(46): 5215-5222
Published online Dec 14, 2018. doi: 10.3748/wjg.v24.i46.5215
Management of sub-centimeter recurrent hepatocellular carcinoma after curative treatment: Current status and future
Min Woo Lee, Hyo Keun Lim
Min Woo Lee, Hyo Keun Lim, Department of Radiology and Center for Imaging Science, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul 06351, South Korea
Min Woo Lee, Hyo Keun Lim, Department of Health Sciences and Technology, SAIHST, Sungkyunkwan University, Seoul 06351, South Korea
Author contributions: Lee MW designed the review, performed the literature search, and wrote the paper; Lim HK supervised and approved the final version of the review.
Conflict-of-interest statement: The authors declare no potential conflicts 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: http://creativecommons.org/licenses/by-nc/4.0/
Corresponding author to: Hyo Keun Lim, MD, PhD, Professor, Department of Radiology, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81 Ilwon-Ro, Kangnam-Ku, Seoul 06351, South Korea. rfalim@skku.edu
Telephone: +82-2-34102518 Fax: +82-2-34105559
Received: August 29, 2018
Peer-review started: August 29, 2018
First decision: October 14, 2018
Revised: October 24, 2018
Accepted: November 2, 2018
Article in press: November 2, 2018
Published online: December 14, 2018
Abstract

Hepatocellular carcinomas (HCCs) frequently recur despite initial successful surgical resection or local ablation therapy. Diagnostic methods for small HCCs have improved with the introduction of gadoxetic acid-enhanced liver magnetic resonance imaging and diffusion-weighted imaging (DWI). Currently, sub-centimeter recurrent nodules showing typical hallmark imaging findings of HCC are frequently detected in patients with a treatment history for HCC. With five typical magnetic resonance findings, including arterial enhancement, washout on portal or transitional phase, high signal intensity on both T2-weighted image and DWI, and low signal intensity on hepatobiliary phase, sub-centimeter recurrent HCC can be diagnosed with high accuracy. Although more information is needed to determine the treatment of choice, local ablation therapy under fusion imaging and/or contrast-enhanced ultrasound guidance or cone-beam computed tomography-guided chemoembolization seem to be promising as they are effective and safe for the management of sub-centimeter recurrent HCCs.

Keywords: Hepatocellular carcinoma, Recurrence, Sub-centimeter, Ablation, Diagnosis

Core tip: Sub-centimeter recurrent nodules can be diagnosed as hepatocellular carcinomas (HCC) in patients with a history of HCC using five typical magnetic resonance findings, including arterial enhancement, washout on portal or transitional phase, high signal intensity on both T2-weighted image and diffusion-weighted imaging, and low signal intensity on hepatobiliary phase. Local ablation therapy under fusion imaging and/or contrast-enhanced ultrasound guidance or cone-beam computed tomography-guided chemoembolization seems to be promising as they are effective and safe. Further comparative studies are warranted to determine the best treatment options.