Journal of Liver Cancer

Original Articles

Prognostic value of automated CT body composition in hepatocellular carcinoma: a volumetric versus single-slice comparison: Seok Jin Hong, Jeong Hee Yoon, Jae Hyun Kim, Jeongin Yoo, Jeong Min Lee; Received December 15, 2025 Accepted June 8, 2026 Published online August 21, 2026; DOI: https://doi.org/10.17998/jlc.2026.06.08 [Accepted]

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Abstract PDF: Backgrounds/Aims
To compare the prognostic value of fully automated volumetric versus single-slice computed tomography (CT)–derived body composition analysis for predicting overall survival in patients with newly diagnosed hepatocellular carcinoma (HCC).
Methods
In this retrospective study of 448 patients with newly diagnosed HCC, deep-learning algorithm was used to quantify volumetric (L1–L5) and single-slice (L3) skeletal muscle and adipose tissue metrics. Spearman correlation assessed the relationship between volumetric and single-slice body composition metrics. Cox proportional hazards models, adjusted for established clinical prognostic factors, were used to evaluate association between body composition parameters and overall survival. Harrell’s C-index was used to compare prognostic performance of Cox models.
Results
Strong correlations (correlation coefficient≥0.82) were observed between volumetric and single-slice measurements for muscle attenuation, visceral fat index, and subcutaneous fat index, while muscle index demonstrated only moderate correlation (correlation coefficient = 0.50). Single-slice low muscle index (HR, 1.63; 95% CI, 1.15–2.31; p = 0.006), single-slice low muscle attenuation (HR, 1.38; 95% CI, 1.01–1.88; p = 0.045) and volumetric low muscle attenuation (HR, 1.42; 95% CI, 1.03–1.95; p = 0.034) were identified as independent predictors of overall survival. Median follow-up was 6.6 years. The single-slice and volumetric models showed comparable discrimination (C-index, 0.816 vs. 0.817; p = 0.11).
Conclusion
Automated single-slice muscle parameters at the L3 level provides significant prognostic stratification in patients with hepatocellular carcinoma, establishing it as a viable, time-efficient tool for routine oncologic practice. In contrast, automated volumetric body composition assessment did not provide superior discrimination compared with the single-slice approach.

Enhancing non-LR-5 liver lesion diagnoses: the incremental value of serum alpha-fetoprotein and PIVKA-II for detecting hepatocellular carcinoma components: Junghoan Park, Jeong Min Lee, Rae Rim Ryu, Seok Jin Hong; Received December 15, 2025 Accepted May 26, 2026 Published online June 26, 2026; DOI: https://doi.org/10.17998/jlc.2026.05.26 [Accepted]

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Abstract PDF: Backgrounds/Aims
To investigate whether incorporating serum alpha-fetoprotein (AFP) and protein induced by vitamin K absence or antagonist-II (PIVKA-II) into gadoxetic acid-enhanced liver MRI improves the accuracy of differentiating hepatocellular carcinoma (HCC), intrahepatic cholangiocarcinoma (ICC), and combined hepatocellular-cholangiocarcinoma (cHCC-CC) from non-LR-5 lesions.
Methods
This retrospective study included 123 patients comprising 70 HCC, 30 ICC, and 23 cHCC-CC cases who underwent preoperative MRI and tumor marker analysis. Two abdominal radiologists independently interpreted the MRI without markers (Decision 1). Then, lesions were reclassified as HCC if either marker was elevated, regardless of the initial interpretation (Decision 2, biomarker-assisted override strategy). Outcomes included the diagnostic performance for identifying HCC versus non-HCC malignancies and distinguishing the presence of HCC components (HCC or cHCC-CC) from ICC. The McNemar’s test and Cohen’s κ compared diagnostic performance and evaluated interobserver agreement, respectively.
Results
Adding AFP and PIVKA-II (Decision 2) improved the sensitivity and accuracy of detecting HCC components from 62.4–76.3% to 81.7–90.3% (P<0.001) and 66.7–76.4% to 81.3–87.0% (P<0.001), respectively. The overall accuracy for differentiating HCC from non-HCC malignancies did not improve. However, the accuracy for detecting HCC in small tumors (<3 cm) significantly improved from 68.8–72.5% to 81.3–82.5% (P= 0.002–0.008). Interobserver agreement also increased, from moderate (κ = 0.48) to substantial (κ = 0.68) after adding tumor marker values.
Conclusions
In non-LR-5 hepatic lesions, adding AFP and PIVKA-II to MRI interpretations significantly improved the accuracy of identifying HCC components, as well as HCC detection in small tumors.

Enhanced radiofrequency ablation for recurrent hepatocellular carcinoma post-transarterial chemoembolization: a prospective study utilizing twin internally cooled-perfusion electrodes: Sungjun Hwang, Jae Hyun Kim, Sae-Jin Park, Su Jong Yu, Yoon Jun Kim, Jung-Hwan Yoon, Jeong Min Lee; J Liver Cancer. 2025;25(1):91-98. Published online February 7, 2025; DOI: https://doi.org/10.17998/jlc.2025.01.25

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Abstract PDF

Backgrounds/Aims
Radiofrequency ablation (RFA) is widely employed for managing recurrent hepatocellular carcinoma (HCC) following transarterial chemoembolization (TACE). However, local tumor progression (LTP) after treatment remains a significant challenge. This study evaluates the efficacy of saline-perfused bipolar RFA using twin internally cooled-perfusion (TICP) electrodes in managing recurrent HCC post-TACE.
Methods
Between September 2017 and January 2019, 100 patients with 105 nodules (mean diameter, 1.6±0.5 cm) were prospectively enrolled. Bipolar RFA with TICP electrodes was performed under ultrasound-computed tomography/magnetic resonance fusion guidance. The primary outcome was the 2-year cumulative incidence of LTP.
Results
The technical success and technique efficacy rates were 100% and 97%, respectively. During a median follow-up period of 34.0 months (range, 3-41), the estimated LTP rates were 13.3% at 1 year and 17.7% at 2 years. Progression-free survival rates were 37.8% and 27.7% at 1 year and 2 years, respectively.
Conclusions
Saline-perfused bipolar RFA using TICP electrodes demonstrates promising results for recurrent HCC after TACE, achieving high technical success and effective local tumor control rates.

Citations

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Risk Model for Predicting Aggressive Recurrence of Hepatocellular Carcinoma after Microwave Ablation Using MRI and Clinical Parameters
Ran Wei, Mengxuan Zuo, Wang Li, Wendao Liu, Chengzhi Li, Chao An
Radiology: Imaging Cancer.2026;[Epub] CrossRef

Assessment of real-time US-CT/MR-guided percutaneous gold fiducial marker implementation in malignant hepatic tumors for stereotactic body radiation therapy: Sungjun Hwang, Seok-Joo Chun, Eui Kyu Chie, Jeong Min Lee; J Liver Cancer. 2024;24(2):263-273. Published online June 10, 2024; DOI: https://doi.org/10.17998/jlc.2024.06.03

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Abstract PDF

Backgrounds/Aims
This study explored the initial institutional experience of using gold fiducial markers for stereotactic body radiotherapy (SBRT) in treating malignant hepatic tumors using real-time ultrasound-computed tomography (CT)/magnetic resonance (MR) imaging fusion-guided percutaneous placement.
Methods
From May 2021 to August 2023, 19 patients with 25 liver tumors that were invisible on pre-contrast CT received fiducial markers following these guidelines. Postprocedural scans were used to confirm their placement. We assessed technical and clinical success rates and monitored complications. The implantation of fiducial markers facilitating adequate treatment prior to SBRT, which was achieved in 96% of the cases (24 of 25 tumors), was considered technical success. Clinical success was the successful completion of SBRT without evidence of marker displacement and was achieved in 88% of cases (22 of 25 tumors). Complications included one major subcapsular hematoma and marker migration into the right atrium in two cases, which prevented SBRT.
Results
Among the treated tumors, 20 of 24 (83.3%) showed a complete response, three of 24 (12.5%) remained stable, and one of 24 (4.2%) progressed during an average 11.7-month follow-up (range, 2-32 months).
Conclusions
This study confirms that percutaneous gold fiducial marker placement using real-time CT/MR guidance is effective and safe for SBRT in hepatic tumors, but warns of marker migration risks, especially near the hepatic veins and in subcapsular locations. Using fewer markers than traditionally recommended-typically two per patient, the outcomes were still satisfactory, particularly given the increased risk of migration when markers were placed near major hepatic veins.

Citations

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Re-assessing the diagnostic value of the enhancing capsule in hepatocellular carcinoma imaging: Jae Seok Bae, Jeong Min Lee, Bo Yun Hur, Jeongin Yoo, Sae-Jin Park; J Liver Cancer. 2024;24(2):206-216. Published online May 8, 2024; DOI: https://doi.org/10.17998/jlc.2024.05.01

7,037 Views
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4 Web of Science
4 Citations

Abstract PDF Supplementary Material

Backgrounds/Aims
The enhancing capsule (EC) in hepatocellular carcinoma (HCC) diagnosis has received varying degrees of recognition across major guidelines. This study aimed to assess the diagnostic utility of EC in HCC detection.
Methods
We retrospectively analyzed patients who underwent pre-surgical computed tomography (CT) and hepatobiliary agent-enhanced magnetic resonance imaging (HBA-MRI) between January 2016 and December 2019. A single hepatic tumor was confirmed based on the pathology of each patient. Three radiologists independently reviewed the images according to the Liver Imaging Reporting and Data System (LI-RADS) v2018 criteria and reached a consensus. Interobserver agreement for EC before reaching a consensus was quantified using Fleiss κ statistics. The impact of EC on the LI-RADS classification was assessed by comparing the positive predictive values for HCC detection in the presence and absence of EC.
Results
In total, 237 patients (median age, 60 years; 184 men) with 237 observations were included. The interobserver agreement for EC detection was notably low for CT (κ=0.169) and HBA-MRI (κ=0.138). The presence of EC did not significantly alter the positive predictive value for HCC detection in LI-RADS category 5 observations on CT (94.1% [80/85] vs. 94.6% [88/93], P=0.886) or HBAMRI (95.7% [88/92] vs. 90.6% [77/85], P=0.178).
Conclusions
The diagnostic value of EC in HCC diagnosis remains questionable, given its poor interobserver agreement and negligible impact on positive predictive values for HCC detection. This study challenges the emphasis on EC in certain diagnostic guidelines and suggests the need to re-evaluate its role in HCC imaging.

Citations

Citations to this article as recorded by

Focal lesions in the cirrhotic liver: an update on LI-RADS classification and clinical implications
Antonino Andrea Blandino, Federica Vernuccio, Roberto Cannella, Aoife Kilcoyne, Leo L. Tsai, Giuseppe Brancatelli
Digestive and Liver Disease.2026; 58(6): 713. CrossRef
Enhancing Capsule on Dynamic Liver CT: Association With Hepatocellular Carcinoma Diagnosis Using LI-RADS Version 2018
Se Jin Choi, Dong Hwan Kim, Sang Hyun Choi, Yong Moon Shin, Jae Ho Byun
American Journal of Roentgenology.2026;[Epub] CrossRef
Clinical and LI-RADS features on gadoxetic acid‑enhanced MRI for predicting complete response after transarterial chemoembolization in hepatocellular carcinoma > 2 cm
Chuhang Liu, Shuya Tan, Xinpei Hu, Yaoning Chen, Cen Hu, Hanqi Liu, Tong Zhao, Yujia Chen, Yangyang Liu
Abdominal Radiology.2026;[Epub] CrossRef
Value of enhancing capsule for diagnosing hepatocellular carcinoma on MRI: implications for simplifying LI-RADS
Se Jin Choi, Hae Young Kim, So Jung Lee, So Yeon Kim, Hyung Jin Won, Yong Moon Shin, Sang Hyun Choi, Jae Ho Byun
European Radiology.2025; 36(2): 1061. CrossRef

Transarterial Chemoembolization versus Radiofrequency Ablation for Small Hepatocellular Carcinomas with Discrepant Features on Computed Tomography and Magnetic Resonance Imaging: Young Youn Cho, Jung Hee Kwon, Jeong-Hoon Lee, Jeong Min Lee, Jae Young Lee, Hyo-Choel Kim, Jin Wook Chung, Won-mook Choi, Eun Ju Cho, Yoon Jun Kim, Jung-Hwan Yoon, Chung Yong Kim, Hyo-Suk Lee; J Liver Cancer. 2015;15(1):19-29. Published online March 31, 2015; DOI: https://doi.org/10.17998/jlc.15.1.19

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Abstract PDF: Background/Aims
This study compared the outcomes of patients with small hepatocellular carcinomas (HCCs) who were treated using transarterial chemoembolization (TACE) or radiofrequency ablation (RFA).
Methods
This was a post-hoc analysis of a prospective study that evaluated the diagnostic efficacy of magnetic resonance imaging (MRI) and computed tomography (CT). We analyzed 41 small hepatic nodules in 32 patients that showed typical radiologic hallmarks on both CT and gadoxate-enhanced MRI (typical nodules) and 25 small hepatic nodules from 22 patients that showed atypical radiologic hallmarks on CT and typical radiologic hallmarks on MRI (discrepant nodules).
Results
There were no significant differences in the baseline characteristics of the patients with typical and discrepant nodules. Complete response rates 1 month after TACE or RFA were 75.0% (18/24) and 94.1% (16/17; P=0.20), respectively, for the patients with typical nodules and 58.8% (10/17) and 100% (8/8; P=0.05), respectively, for the patients with discrepant nodules. Treatment failure rates after TACE or RFA were 33.3% (8/24) and 5.8% (1/17; P=0.15), respectively, for the patients with typical nodules and 47.0% (8/17) and 0.0% (0/8; P=0.02), respectively, for the patients with discrepant nodules. Among patients achieving complete response, there were no significant differences in the risk of marginal recurrence.
Conclusions
RFA provided higher complete response rates and significantly lower treatment failure rates than TACE for patients with discrepant nodules of HCC. Therefore, a treatment modality such as RFA may be preferable for small HCCs which show discrepancy on two imaging modalities.

Review Article

Hepatocellular Carcinomas with Atypical Imaging Features: Jeong Min Lee, Se Hyung Kim; Journal of the Korean Liver Cancer Study Group. 2003;3(1):30-39. Published online July 31, 2003

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