Published online Jul 27, 2018. doi: 10.4254/wjh.v10.i7.462
Peer-review started: March 27, 2018
First decision: April 18, 2018
Revised: April 25, 2018
Accepted: May 30, 2018
Article in press: May 30, 2018
Published online: July 27, 2018
To date the imaging diagnosis of liver lesions is based mainly on the identification of vascular features, which are typical of overt hepatocellular carcinoma (HCC), but the hepatocarcinogenesis is a complex and multistep event during which, a spectrum of nodules develop within the liver parenchyma, including benign small and large regenerative nodule (RN), low-grade dysplastic nodule (LGDN), high-grade dysplastic nodule (HGDN), early HCC, and well differentiated HCC. These nodules may be characterised not only on the basis of their respective different blood supplies, but also on their different hepatocyte function. Recently, in liver imaging the introduction of hepatobiliary magnetic resonance imaging contrast agent offered the clinicians the possibility to obtain, at once, information not only related to the vascular changes of liver nodules but also information on hepatocyte function. For this reasons this new approach becomes the most relevant diagnostic clue for differentiating low-risk nodules (LGDN-RN) from high-risk nodules (HGDN/early HCC or overt HCC) and consequently new diagnostic algorithms for HCC have been proposed. The use of hepatobiliary contrast agents is constantly increasing and gradually changing the standard of diagnosis of HCC. The main purpose of this review is to underline the added value of Gd-EOB-DTPA in early-stage diagnoses of HCC. We also analyse the guidelines for the diagnosis and management of HCC, the key concepts of HCC development, growth and spread and the imaging appearance of precursor nodules that eventually may transform into overt HCC.
Core tip: Hepatobiliary contrast agents improve detection and characterization of focal liver lesions in patients with cirrhotic liver. Gd-EOB-DTPA provides information not only on vascular changes but also on hepatocyte function. Based on the recent advances in liver magnetic resonance imaging (MRI) technology, in this review, we discuss the pivotal role of Gd-EOB-DTPA enhanced MRI for the future of hepatocellular carcinoma’s management.