Journal of Liver Cancer

Review Articles

Preventing false positive imaging diagnosis of HCC: differentiating HCC from mimickers and practical strategies: Ijin Joo; J Liver Cancer. 2025;25(2):217-232. Published online July 31, 2025; DOI: https://doi.org/10.17998/jlc.2025.07.29

9,912 Views
138 Downloads
4 Web of Science
7 Citations

Noninvasive imaging-based diagnosis of hepatocellular carcinoma (HCC) in high-risk patients plays a central role in clinical practice. Current major guidelines typically rely on the radiologic hallmark of nonrim arterial phase hyperenhancement followed by nonperipheral washout, criteria designed to achieve both high positive predictive value and sufficient specificity when applied within well-defined target populations. Despite these criteria, false positive diagnoses still occur and can lead to unnecessary or inappropriate treatment, as various benign and non-HCC malignant lesions may exhibit vascular features that overlap with the classic appearance of HCC. Furthermore, treatment decisions are occasionally guided by imaging findings even in patients outside the target population who are being evaluated for possible HCC, in whom vascular patterns are less specific and the risk of false positive diagnosis is inherently higher. Minimizing the risk of false positive diagnosis requires not only adherence to validated imaging criteria but also clinical and contextual integration when findings are uncertain. This includes consideration of ancillary features, tumor markers, and, when appropriate, further evaluation through biopsy, additional imaging, or follow-up. This review outlines a range of HCC mimickers and provides practical strategies to support accurate imaging interpretation and reduce false positive diagnoses in clinical practice.

Citations

Citations to this article as recorded by

Diagnostic Accuracy of Extracellular versus Hepatobiliary Contrast-enhanced MRI in LI-RADS Nonradiation Treatment Response Algorithm Version 2024
Subin Heo, Yong Jun Jung, Eun Sun Choi, Sehee Kim, Kyoung Won Kim, Young-In Yoon, Hyung Jin Won, Yong Moon Shin, Dong Hwan Kim, Sang Hyun Choi
Radiology.2026;[Epub] CrossRef
“WBC-HBP Dissociation” Unveils Occult Xanthogranulomatous Inflammation Mimicking Hepatocellular Carcinoma in Diabetic Patients
Xuan-Yi Zhu, Kai-Chi Liu, Ze-Bin Zhu, Shu-Geng Zhang
Journal of Hepatocellular Carcinoma.2026; Volume 13: 1. CrossRef
Gadoxetate-enhanced MRI Transitional Phase Parenchymal Signal: Effect on Washout and LI-RADS Diagnostic Performance for Hepatocellular Carcinoma
Seong Hyeon Cho, Yong Jun Jung, Seung Baek Hong, Se Jin Choi, Seung Soo Lee, Jae Ho Byun, Hyung Jin Won, Yong Moon Shin, Subin Heo, Sang Hyun Choi
Radiology.2026;[Epub] CrossRef
Imaging differentiation of hepatocellular carcinoma, combined hepatocellular-cholangiocarcinoma, and intrahepatic cholangiocarcinoma: pitfalls and advances
Jaeseung Shin, Taek Chung, Sang Yun Ha, Hyungjin Rhee
Journal of Liver Cancer.2026; 26(1): 9. CrossRef
Advances in the Management of Hepatocellular Carcinoma: Evolving Systemic Therapy, Perioperative Strategies, and Care for Special Populations
Jing He, Xiao-Qin Wu, Zhen-Guang Wang
Journal of Clinical Question.2026;[Epub] CrossRef
Focal Nodular Hyperplasia Mimicking Hepatocellular Carcinoma in Chronic Hepatitis B Represents a Diagnostic Pitfall
Tom Ryu, Soung Won Jeong, Young Chang, Jae Young Jang
Clinical Ultrasound.2026; 11(1): 80. CrossRef
Advances in the imaging of liver cancer
Ijin Joo, Jeong Min Lee, Maxime Ronot
Journal of Hepatology.2026;[Epub] CrossRef

Insights into hepatocellular adenomas in Asia: molecular subtypes, clinical characteristics, imaging features, and hepatocellular carcinoma risks: Subin Heo, In Hye Song, Edouard Reizine, Maxime Ronot, Jean-Charles Nault, Hae Young Kim, Sang Hyun Choi, So Yeon Kim; J Liver Cancer. 2025;25(1):67-78. Published online March 7, 2025; DOI: https://doi.org/10.17998/jlc.2025.03.06

8,302 Views
192 Downloads
6 Web of Science
5 Citations

Abstract PDF

Hepatocellular adenomas (HCAs) are benign monoclonal liver tumors. Advances in molecular studies have led to the identification of distinct subtypes of HCA with unique pathways, clinical characteristics, and complication risks, underscoring the need for precise diagnosis and tailored management. Malignant transformation and bleeding remain significant concerns. Imaging plays a crucial role in the identification of these subtypes, offering a non-invasive method to guide clinical decision-making. Most studies involving patients with HCAs have been conducted in Western populations; however, the number of studies focused on Asian population has increased in recent years. HCAs exhibit distinct features in Asian population, such as a higher prevalence among male patients and specific subtypes (e.g., inflammatory HCAs). Current clinical guidelines are predominantly influenced by Western data, which may not fully capture these regional differences in epidemiology and subtype distribution. Therefore, this review presents the updated molecular classification of HCAs and their epidemiologic differences between Asian and Western populations, and discuss the role of imaging techniques, particularly magnetic resonance imaging using hepatobiliary contrast agents, in classifying the subtypes and predicting the risk of hepatocellular carcinoma.

Citations

Citations to this article as recorded by

A case of β-catenin-activated hepatocellular adenoma with concurrent hepatocellular carcinoma
Daichi Ito, Ryota Hyodo, Keisuke Kurimoto, Takashi Mizuno, Akira Satou, Motoko Sasaki, Yoji Ishizu, Mami Iima, Shinji Naganawa
Abdominal Radiology.2026;[Epub] CrossRef
Gravitational 3D Magnetic Resonance Elastography for Differentiating Focal Nodular Hyperplasia and Hepatic Adenoma
Leon David Gruenewald, Shayan Mansouri, Christian Booz, Jennifer Gotta, Philipp Reschke, Tommaso D’Angelo, Mohamed Alrahmoun, Scherwin Mahmoudi, Simon S. Martin, Katrin Eichler, Tatjana Gruber-Rouh, Stefan Zeuzem, Esra Görgülü, Melis Onay, Eva Herrmann, M
Diagnostics.2026; 16(10): 1569. CrossRef
The natural history of hepatocellular adenoma: long-term outcomes from a large tertiary centre
Evangelia Florou, Anushka Jindal, Mohammad Reza Fattahi, Nigel Heaton, Parthi Srinivasan
European Journal of Gastroenterology & Hepatology.2026;[Epub] CrossRef
Stellenwert der KM-verstärkten Sonografie der Leber
Thomas Ybinger, Vuk Matic, Thomas Gruenberger, Sophia Petschnak, Christian Krestan
RöFo - Fortschritte auf dem Gebiet der Röntgenstrahlen und der bildgebenden Verfahren.2026;[Epub] CrossRef
Preventing false positive imaging diagnosis of HCC: differentiating HCC from mimickers and practical strategies
Ijin Joo
Journal of Liver Cancer.2025; 25(2): 217. CrossRef

Recent advances and issues in imaging modalities for hepatocellular carcinoma surveillance: Dong Ho Lee; J Liver Cancer. 2025;25(1):31-40. Published online February 26, 2025; DOI: https://doi.org/10.17998/jlc.2025.02.16

20,813 Views
268 Downloads
15 Web of Science
18 Citations

Abstract PDF

Hepatocellular carcinoma (HCC) is a leading cause of cancer-related mortality worldwide. Early detection via surveillance plays a crucial role in enabling curative treatment and improving survival rates. Since the initial randomized controlled trial, biannual ultrasound (US) has been established as the standard surveillance method because of its accessibility, safety, and low cost. However, US has some limitations, including operator dependency, suboptimal sensitivity for early-stage HCC, and challenges such as a limited sonic window that may result in inadequate examination. Alternative imaging modalities, including contrast-enhanced computed tomography (CT) and magnetic resonance imaging (MRI), have demonstrated higher sensitivity for detecting very early-stage HCC. Recent advancements, such as low-dose CT with deep learning-based reconstruction, have enhanced the safety and feasibility of CT-based surveillance by reducing radiation exposure and amount of contrast media. MRI, particularly with gadoxetic acid or abbreviated protocols, offers superior tissue contrast and sensitivity, although its accessibility and cost remain challenges. Tailored surveillance strategies based on individual risk profiles and integration of advanced imaging technologies have the potential to enhance the detection performance and cost-effectiveness. This review highlights the recent developments in imaging technologies for HCC surveillance, focusing on their respective strengths and limitations.

Citations

Citations to this article as recorded by

Gadoxetic acid-enhanced MRI in hepatocellular carcinoma: a comprehensive review of diagnostic, surveillance, and treatment response prediction and assessment
Kumi Ozaki, Yukichi Tanahashi, Satoshi Goshima
Japanese Journal of Radiology.2026; 44(1): 2. CrossRef
Pioneering efficient deep learning architectures for enhanced hepatocellular carcinoma prediction and clinical translation
Sami Akbulut, Cemil Colak
World Journal of Gastrointestinal Oncology.2026;[Epub] CrossRef
Advancements in intratumoral therapies for liver tumors
Steven S. Raman, Neal R. Cutler, John J. Sramek, J. Randolph Hecht, Richard S. Finn, Sidharth R. Anand, Jason Chiang, David S. Lu
Frontiers in Oncology.2026;[Epub] CrossRef
A dual-mode photoelectrochemical/electrochemical detection approach for circulating tumour cells in hepatocellular carcinoma based on a bifunctional aptamer recognition strategy
Yi Xue, Junyan Tang, Zonglin Li, Long Sun, Fei Wang
Microchemical Journal.2026; 224: 117658. CrossRef
Novel lncRNA Signature (UFC1/PTENP1) as a Molecular Biomarker for the Diagnosis and Prognosis of Hepatocellular Carcinoma in an Egyptian Cohort
Marwa Hassan, Lobna Abdelsalam, Amal Kotb Behery, Rania Fathy Elnahas
Current Issues in Molecular Biology.2026; 48(4): 360. CrossRef
Correspondence to editorial on “Non-contrast magnetic resonance imaging for detection of late recurrent hepatocellular carcinoma after curative treatment: a prospective multicenter comparison to contrast-enhanced computed tomography”
Dong Ho Lee
Clinical and Molecular Hepatology.2026; 32(2): e221. CrossRef
Correspondence to letter to the editor on “Non-contrast magnetic resonance imaging for detection of late recurrent hepatocellular carcinoma after curative treatment: a prospective multicenter comparison to contrast-enhanced computed tomography”
Dong Ho Lee
Clinical and Molecular Hepatology.2026; 32(2): e251. CrossRef
Interreader Agreement for Individual Ancillary Features in LI-RADS CT/MRI Version 2018: A Systematic Review and Meta-Analysis
Yong Jun Jung, Sang Hyun Choi, Subin Heo, Dong Hwan Kim, Suk Kim, Seung Baek Hong
American Journal of Roentgenology.2026; : 1. CrossRef
The Role of MicroRNAs in Hepatocellular Carcinoma: From Tumorigenesis to Biomarker Applications
Hyunjin Park, Seunghye Kim, Jeong Eun Yoo, Haeryoung Kim
Journal of Digestive Cancer Research.2026; 14(1): 93. CrossRef
Artificial Intelligence in Oncology: A Comprehensive Cross-Cancer Translational Readiness Analysis Across 18 Malignancies
Sai Kiran Kuchana, Uday Kumar Repalle, Nikhilesh V. Alahari, Manpreet Kondamuri, Sai Kiran Manduva, Raghu Vamsi Vanguru, Sri Anjali Gorle, Suresh K. Alahari
Cancers.2026; 18(10): 1543. CrossRef
Advances in the imaging of liver cancer
Ijin Joo, Jeong Min Lee, Maxime Ronot
Journal of Hepatology.2026;[Epub] CrossRef
Development of a longitudinal predictive model for hepatocellular carcinoma occurrence in patients with chronic hepatitis B
Apichat Kaewdech, Chanavee Toh, Pimsiri Sripongpun, Naichaya Chamroonkul, Pisit Tangkijvanich, Teerha Piratvisuth, Suthat Liangpunsakul, Paramee Thongsuksai, Thammasin Ingviya
Scientific Reports.2026;[Epub] CrossRef
Correspondence to letter to the editor on “Non-contrast magnetic resonance imaging for detection of late recurrent hepatocellular carcinoma after curative treatment: a prospective multicenter comparison to contrast-enhanced computed tomography”
Dong Ho Lee
Clinical and Molecular Hepatology.2026; 32(3): e402. CrossRef
Intrahepatic Lymphoid Follicles Comprising T and B Cells Mimic Hepatocellular Carcinoma in a Hepatitis B Patient
Ji Yeon Lee, Jaejun Lee, Pil Soo Sung
International Journal of Molecular Sciences.2025; 26(10): 4823. CrossRef
Non-contrast magnetic resonance imaging for detection of late recurrent hepatocellular carcinoma after curative treatment: a prospective multicenter comparison to contrast-enhanced computed tomography
Dong Wook Kim, Won Chang, So Yeon Kim, Young-Suk Lim, Jonggi Choi, Jungheum Cho, Jin-Wook Kim, Jai Young Cho, Sun Kyung Jeon, Yun Bin Lee, Eun Ju Cho, Su Jong Yu, Kyung-Suk Suh, Kwang-Woong Lee, Dong Ho Lee
Clinical and Molecular Hepatology.2025; 31(4): 1285. CrossRef
A contrast‑enhanced CT histogram‑driven nomogram for predicting post‑radiotherapy liver regeneration in hepatocellular carcinoma
Bo Liu, Yuan Xu, Xijie Zhang, Wei Qi, Bo Ren, Wenjia Kong, Wence Zhou
Radiation Oncology.2025;[Epub] CrossRef
Identification of Novel Hepatic Target Genes of miR‐192‐5p
Yoshifumi Saito, Akari Obayashi, Riho Ichikawa, Wakana Iwasaki, Yuya Kato, Kazumi Ninomiya, Yusuke Inoue
Genes to Cells.2025;[Epub] CrossRef
Progress in the Synthesis and Application of Phycocyanin-Based Nanoparticles
Fatemeh Rahmati-Dehkordi, Siavash Abdolghaderi, Felora Ferdosi, Neda Ebrahimi, Abdolkarim Talebi Taheri, Ehsan Dadgostar, Fatemeh Nabavizadeh, Mehdi Shafiee Ardestani, Mozhdeh Mohammadpour, Rajender S. Varma, Omid Reza Tamtaji
Topics in Current Chemistry.2025;[Epub] CrossRef

First
Prev
Page of 1
Next
Last

Search