Journal of Liver Cancer

Review Articles

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; Received February 7, 2025 Accepted March 6, 2025 Published online March 7, 2025; DOI: https://doi.org/10.17998/jlc.2025.03.06 [Accepted]

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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.

Recent advances and issues in imaging modalities for hepatocellular carcinoma surveillance: Dong Ho Lee; Received December 28, 2024 Accepted February 16, 2025 Published online February 26, 2025; DOI: https://doi.org/10.17998/jlc.2025.02.16 [Epub ahead of print]

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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.

Imaging prognostication and tumor biology in hepatocellular carcinoma: Diana Kadi, Marilyn F. Yamamoto, Emily C. Lerner, Hanyu Jiang, Kathryn J. Fowler, Mustafa R. Bashir; J Liver Cancer. 2023;23(2):284-299. Published online September 15, 2023; DOI: https://doi.org/10.17998/jlc.2023.08.29

4,572 Views
149 Downloads
1 Citation

Abstract PDF

Hepatocellular carcinoma (HCC) is the most common primary liver malignancy, and represents a significant global health burden with rising incidence rates, despite a more thorough understanding of the etiology and biology of HCC, as well as advancements in diagnosis and treatment modalities. According to emerging evidence, imaging features related to tumor aggressiveness can offer relevant prognostic information, hence validation of imaging prognostic features may allow for better noninvasive outcomes prediction and inform the selection of tailored therapies, ultimately improving survival outcomes for patients with HCC.

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Membranous Overexpression of Fibronectin Predicts Microvascular Invasion and Poor Survival Outcomes in Patients with Hepatocellular Carcinoma
Yoon Jung Hwang, Hyejung Lee, Suk Kyun Hong, Su Jong Yu, Haeryoung Kim
Gut and Liver.2025; 19(2): 275. CrossRef

Radiologic features of hepatocellular carcinoma related to prognosis: Shin Hye Hwang, Hyungjin Rhee; J Liver Cancer. 2023;23(1):143-156. Published online March 9, 2023; DOI: https://doi.org/10.17998/jlc.2023.02.16

3,689 Views
175 Downloads
11 Citations

Abstract PDF

The cross-sectional imaging findings play a crucial role in the diagnosis of hepatocellular carcinoma (HCC). Recent studies have shown that imaging findings of HCC are not only relevant for the diagnosis of HCC, but also for identifying genetic and pathologic characteristics and determining prognosis. Imaging findings such as rim arterial phase hyperenhancement, arterial phase peritumoral hyperenhancement, hepatobiliary phase peritumoral hypointensity, non-smooth tumor margin, low apparent diffusion coefficient, and the LR-M category of the Liver Imaging-Reporting and Data System have been reported to be associated with poor prognosis. In contrast, imaging findings such as enhancing capsule appearance, hepatobiliary phase hyperintensity, and fat in mass have been reported to be associated with a favorable prognosis. Most of these imaging findings were examined in retrospective, single-center studies that were not adequately validated. However, the imaging findings can be applied for deciding the treatment strategy for HCC, if their significance can be confirmed by a large multicenter study. In this literature, we would like to review imaging findings related to the prognosis of HCC as well as their associated clinicopathological characteristics.

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A Nomogram Based on MRI Visual Decision Tree to Evaluate Vascular Endothelial Growth Factor in Hepatocellular Carcinoma
Hanting Dai, Chuan Yan, Wanrong Huang, Yifan Pan, Feng Pan, Yamei Liu, Shunli Wang, Huifang Wang, Rongping Ye, Yueming Li
Journal of Magnetic Resonance Imaging.2025; 61(2): 970. CrossRef
Prediction early recurrence of hepatocellular carcinoma after hepatectomy using gadoxetic acid-enhanced MRI and IVIM
Da Guo, Liping Liu, Yu Jin
European Journal of Radiology Open.2025; 14: 100643. CrossRef
Radiomics and machine learning based on preoperative MRI for predicting extrahepatic metastasis in hepatocellular carcinoma patients treated with transarterial chemoembolization
Gang Peng, Xiaojing Cao, Xiaoyu Huang, Xiang Zhou
European Journal of Radiology Open.2024; 12: 100551. CrossRef
Clinical Parameters Work Well as Predictive Factors for Atezolizumab and Bevacizumab Treatment in Hepatocellular Carcinoma
Ji Yeon Lee, Pil Soo Sung
Gut and Liver.2024; 18(4): 558. CrossRef
Advances in Understanding Hepatocellular Carcinoma Vasculature: Implications for Diagnosis, Prognostication, and Treatment
Hyungjin Rhee, Young Nyun Park, Jin-Young Choi
Korean Journal of Radiology.2024; 25(10): 887. CrossRef
Inter-reader agreement for CT/MRI LI-RADS category M imaging features: a systematic review and meta-analysis
Dong Hwan Kim, Sang Hyun Choi
Journal of Liver Cancer.2024; 24(2): 192. CrossRef
Gd-EOB-DTPA-enhanced MR imaging features of hepatocellular carcinoma in non-cirrhotic liver
Mingyue Song, Yuhao Tao, Hanjun Zhang, Mingzhan Du, Lingchuan Guo, Chunhong Hu, Weiguo Zhang
Magnetic Resonance Imaging.2024; 114: 110241. CrossRef
Prediction of PD-L1 expression in unresectable hepatocellular carcinoma with gadoxetic acid-enhanced MRI
Jun Gu Kang, Kyunghwa Han, Taek Chung, Hyungjin Rhee
European Journal of Radiology.2024; 181: 111772. CrossRef
The histopathological and molecular heterogeneity of hepatocellular carcinoma: a narrative review
Wonju Chung, Haeryoung Kim
The Ewha Medical Journal.2024;[Epub] CrossRef
Gadoxetic Acid-Enhanced Magnetic Resonance Imaging Features Can Predict Immune-Excluded Phenotype of Hepatocellular Carcinoma
Eisuke Ueshima, Keitaro Sofue, Takahiro Kodama, Shuhei Yamamoto, Masato Komatsu, Shohei Komatsu, Nobuaki Ishihara, Akihiro Umeno, Takeru Yamaguchi, Masatoshi Hori, Takumi Fukumoto, Tetsuo Takehara, Takamichi Murakami
Liver Cancer.2024; : 1. CrossRef
Imaging prognostication and tumor biology in hepatocellular carcinoma
Diana Kadi, Marilyn F. Yamamoto, Emily C. Lerner, Hanyu Jiang, Kathryn J. Fowler, Mustafa R. Bashir
Journal of Liver Cancer.2023; 23(2): 284. CrossRef

Original Article

Diagnostic performance of the 2022 KLCA-NCC criteria for hepatocellular carcinoma on magnetic resonance imaging with extracellular contrast and hepatobiliary agents: comparison with the 2018 KLCA-NCC criteria: Ja Kyung Yoon, Sunyoung Lee, Jeong Ah Hwang, Ji Eun Lee, Seung-seob Kim, Myeong-Jin Kim; J Liver Cancer. 2023;23(1):157-165. Published online February 23, 2023; DOI: https://doi.org/10.17998/jlc.2023.02.07

2,812 Views
111 Downloads
1 Citation

Abstract PDF Supplementary Material

Background/Aim
This study aimed to determine the diagnostic performance of 2022 Korean Liver Cancer Association-National Cancer Center (KLCA-NCC) imaging criteria compared with the 2018 KLCA-NCC for hepatocellular carcinoma (HCC) in high-risk patients using magnetic resonance imaging (MRI).
Methods
This retrospective study included 415 treatment-naïve patients (152 patients who underwent extracellular contrast agent [ECA]-MRI and 263 who underwent hepatobiliary agent [HBA]-MRI; 535 lesions, including 412 HCCs) with a high risk of HCC who underwent contrast-enhanced MRI. Two readers evaluated all lesions according to the 2018 and 2022 KLCA-NCC imaging diagnostic criteria, and the per-lesion diagnostic performances were compared.
Results
In “definite” HCC category of both 2018 and 2022 KLCA-NCC, HBA-MRI showed a significantly higher sensitivity for the diagnosis of HCC than ECA-MRI (77.0% vs. 64.3%, P=0.006) without a significant difference in specificity (94.7% vs. 95.7%, P=0.801). On ECAMRI, “definite” or “probable” HCC categories of the 2022 KLCA-NCC had significantly higher sensitivity than those of the 2018 KLCA-NCC (85.3% vs. 78.3%, P=0.002) with identical specificity (93.6%). On HBA-MRI, the sensitivity and specificity of “definite” or “probable” HCC categories of both 2018 and 2022 KLCA-NCC were not significantly different (83.3% vs. 83.6%, P>0.999 and 92.1% vs. 90.8%, P>0.999, respectively).
Conclusions
In “definite” HCC category of both 2018 and 2022 KLCA-NCC, HBA-MRI provides better sensitivity than ECA-MRI without compromising specificity. On ECA-MRI, “definite” or “probable” HCC categories of the 2022 KLCA-NCC may improve sensitivity in the diagnosis of HCC compared with the 2018 KLCA-NCC.

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Impact of the updated KLCA-NCC criteria for diagnosis of “probable HCC” in liver MRI: comparisons between KLCA v2022 and v2018
Jeong Hee Yoon
Journal of Liver Cancer.2023; 23(1): 124. CrossRef

Review Articles

Update on Pathologic and Radiologic Diagnosis of Combined Hepatocellular-Cholangiocarcinoma: Hyungjin Rhee, Jae Hyon Park, Young Nyun Park; J Liver Cancer. 2021;21(1):12-24. Published online March 31, 2021; DOI: https://doi.org/10.17998/jlc.21.1.12

7,787 Views
350 Downloads
5 Citations

Abstract PDF

Combined hepatocellular-cholangiocarcinoma (cHCC-CCA) is a malignant primary liver carcinoma characterized by the unequivocal presence of both hepatocytic and cholangiocytic differentiation within the same tumor. Recent research has highlighted that cHCC-CCAs are more heterogeneous than previously expected. In the updated consensus terminology and WHO 2019 classification, “classical type” and “subtypes with stem-cell features” of the WHO 2010 classification are no longer recommended. Instead, it is recommended that the presence and percentages of various histopathologic components and stem-cell features be mentioned in the pathologic report. The new terminology and classification enable the exchange of clearer and more objective information about cHCC-CCAs, facilitating multi-center and multinational research. However, there are limitations to the diagnosis of cHCC-CCA by imaging and biopsy. cHCC-CCAs showing typical imaging findings of HCC could be misdiagnosed as HCC and subjected to inappropriate treatment, if other clinical findings are not sufficiently considered. cHCC-CCAs showing at least one of the CCA-like imaging features or unusual clinical features should be subjected to biopsy. There may be a sampling error for the biopsy diagnosis of cHCC-CCA. An optimized diagnostic algorithm integrating clinical, radiological, and histopathologic information of biopsy is required to resolve these diagnostic pitfalls.

Citations

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Enhancing liver cirrhosis varices and CSPH risk prediction with spleen stiffness measurement using 100-Hz probe
Jeong-Ju Yoo, Sun Ah Maeng, Young Chang, Sae Hwan Lee, Soung Won Jeong, Jae Young Jang, Gab Jin Cheon, Young Seok Kim, Hong Soo Kim, Sang Gyune Kim
Scientific Reports.2024;[Epub] CrossRef
MRI features of combined hepatocellular-cholangiocarcinoma
Noor Fatima Majeed, Mathew Macey, Marta Braschi Amirfarzan, Sheida Sharifi, Jeremy R Wortman
Abdominal Radiology.2024; 50(1): 169. CrossRef
Imaging findings of intrahepatic cholangiocarcinoma for prognosis prediction and treatment decision-making: a narrative review
Jun Gu Kang, Taek Chung, Dong Kyu Kim, Hyungjin Rhee
The Ewha Medical Journal.2024;[Epub] CrossRef
Differentiation between hepatic angiomyolipoma and hepatocellular carcinoma in individuals who are not at-risk for hepatocellular carcinoma
Sungtae Park, Myeong-Jin Kim, Kyunghwa Han, Jae Hyon Park, Dai Hoon Han, Young Nyun Park, Jaehyo Kim, Hyungjin Rhee
European Journal of Radiology.2023; 166: 110957. CrossRef
The Human TOR Signaling Regulator Is the Key Indicator of Liver Cancer Patients’ Overall Survival: TIPRL/LC3/CD133/CD44 as Potential Biomarkers for Early Liver Cancers
Soo Young Jun, Hyang Ran Yoon, Ji-Yong Yoon, Su-Jin Jeon, Jeong-Ju Lee, Debasish Halder, Jin-Man Kim, Nam-Soon Kim
Cancers.2021; 13(12): 2925. CrossRef

Imaging Modalities for Hepatocellular Carcinoma Surveillance: Expanding Horizons beyond Ultrasound: Hyo Jung Park, So Yeon Kim; J Liver Cancer. 2020;20(2):99-105. Published online September 30, 2020; DOI: https://doi.org/10.17998/jlc.20.2.99

7,453 Views
236 Downloads
3 Citations

Abstract PDF

In Asian countries favoring loco-regional treatment such as surgical resection or ablation, very early-stage hepatocellular carcinoma (HCC) should be the main target for surveillance. Even though ultrasound (US) has been accepted as a primary imaging modality for HCC surveillance, its performance in detecting very early-stage HCCs is insufficient. Moreover, in more than 20% of patients at high risk for HCC, visualization of the liver on US may be limited owing to the advanced distortion and heterogeneity of the liver parenchyma. Recently revised HCC clinical guidelines allow the use of alternative surveillance tools including computed tomography or magnetic resonance imaging in patients with inadequate US exams. This paper summarizes the findings of recent studies using imaging modalities other than US as surveillance tools for HCC as well as strengths and limitations of these modalities.

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Long‐Term Outcome of Chronic Hepatitis B—Histological Score and Viral Genotype Are Important Predictors of Hepatocellular Carcinoma
Anders Eilard, Johan Ringlander, Maria E. Andersson, Staffan Nilsson, Gunnar Norkrans, Magnus Lindh
Journal of Viral Hepatitis.2025;[Epub] CrossRef
Advanced Imaging of Hepatocellular Carcinoma: A Review of Current and Novel Techniques
Trinh Nguyen, Jaijo Vennatt, Lincoln Downs, Venkateswar Surabhi, Nir Stanietzky
Journal of Gastrointestinal Cancer.2024; 55(4): 1469. CrossRef
Imaging features of hepatobiliary MRI and the risk of hepatocellular carcinoma development
Jong-In Chang, Dong Hyun Sinn, Woo Kyoung Jeong, Jeong Ah Hwang, Ho Young Won, Kyunga Kim, Wonseok Kang, Geum-Youn Gwak, Yong-Han Paik, Moon Seok Choi, Joon Hyeok Lee, Kwang Cheol Koh, Seung-Woon Paik
Scandinavian Journal of Gastroenterology.2022; 57(12): 1470. CrossRef

Original Article

Validation of the Korean Liver Cancer Association-National Cancer Center 2018 Criteria for the Noninvasive Diagnosis of Hepatocellular Carcinoma Using Magnetic Resonance Imaging: Sunyoung Lee, Myeong-Jin Kim; J Liver Cancer. 2020;20(2):120-127. Published online September 30, 2020; DOI: https://doi.org/10.17998/jlc.20.2.120

3,814 Views
91 Downloads
2 Citations

Abstract PDF

Background/Aims
This study aimed to assess the validity and diagnostic performance of the imaging criteria of Korean Liver Cancer Association-National Cancer Center (KLCA-NCC) 2018 using magnetic resonance imaging (MRI) in high-risk patients for HCC.
Methods
This retrospective study included 142 treatment-naïve patients (81 patients who underwent MRI with extracellular contrast agent and 61 who underwent MRI with hepatobiliary agent; 183 lesions including 149 HCCs) with a high risk of HCC who underwent multiphasic contrast-enhanced MRI from January to December 2015. All lesions were categorized according to the KLCA-NCC 2018 imaging diagnostic criteria by two readers, and per-lesion diagnostic performances were compared.
Results
According to the KLCA-NCC 2018, none (0%) of the 13 benign category lesions, 11 (44.0%) of 25 indeterminate category lesions, 15 (93.8%) of 16 probable HCC category lesions, and 97 (99.0%) of 98 definite HCC category lesions were ultimately diagnosed as HCCs. The sensitivity and specificity of definite HCC category were 65.1% and 97.1%, respectively, and those of the combination of definite and probable HCC categories were 75.2% and 94.1%, respectively. The sensitivity of the combination of definite and probable HCC categories was significantly higher than that of definite HCC (P<0.001), but the specificity was not significantly lower (P>0.999).
Conclusions
The noninvasive imaging diagnosis of KLCA-NCC 2018 on MRI is reliable and useful for diagnosing HCC in high-risk patients. Combining definite and probable HCC categories of KLCA-NCC 2018 improves the sensitivity while maintaining a high specificity.

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Intraindividual Comparison of MRIs with Extracellular and Hepatobiliary Contrast Agents for the Noninvasive Diagnosis of Hepatocellular Carcinoma Using the Korean Liver Cancer Association–National Cancer Center 2022 Criteria
Ja Kyung Yoon, Dai Hoon Han, Sunyoung Lee, Jin-Young Choi, Gi Hong Choi, Do Young Kim, Myeong-Jin Kim
Cancer Research and Treatment.2023; 55(3): 939. CrossRef
Diagnostic Performance of KLCA-NCC 2018 Criteria for Hepatocellular Carcinoma Using Magnetic Resonance Imaging: A Systematic Review and Meta-Analysis
Dong Hwan Kim, Bohyun Kim, Seo Yeon Youn, Hokun Kim, Joon-Il Choi
Diagnostics.2021; 11(10): 1763. CrossRef

Review Article

Liver Magnetic Resonance Imaging for Hepatocellular Carcinoma Surveillance: So Hyun Park, Bohyun Kim; J Liver Cancer. 2020;20(1):25-31. Published online March 31, 2020; DOI: https://doi.org/10.17998/jlc.20.1.25

7,408 Views
272 Downloads
6 Citations

Abstract PDF

Hepatocellular carcinoma (HCC) surveillance is recommended when the annual incidence of HCC exceeds 1.5%. In 2018, several international guidelines included alternative surveillance modalities, such as computed tomography and magnetic resonance imaging (MRI), as alternatives for patients with inadequate surveillance with an ultrasound. Currently, abbreviated MRI selectively includes several key sequences and is emerging as an effective tool for HCC surveillance with reduced cost and scan time and the required diagnostic performance. The incidence of HCC substantially impacts the benefits of surveillance in terms of cost-effectiveness. Therefore, we need to individualize imaging surveillance of HCC, tailor screening, and determine risk-stratified strategies. The purpose of this article was to present a brief overview of the diagnostic performance and cost-effectiveness of liver MRI as an HCC surveillance tool.

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A Post-International Gastrointestinal Cancers’ Conference (IGICC) Position Statements
Suayib Yalcin, Sahin Lacin, Ahmed Kaseb, Bora Peynircioğlu, Murat Cantasdemir, Barbaros Çil, Pervin Hurmuz, Ahmet Doğrul, Murat Bozkurt, Hüseyin Abali, Okan Akhan, Halis Şimşek, Berksoy Sahin, Faruk Aykan, İdris Yücel, Gürkan Tellioğlu, Fatih Selçukbirici
Journal of Hepatocellular Carcinoma.2024; Volume 11: 953. CrossRef
Adding MRI as a Surveillance Test for Hepatocellular Carcinoma in Patients with Liver Cirrhosis Can Improve Prognosis
Su Jong Yu, Jeong-Ju Yoo, Dong Ho Lee, Su Jin Kim, Eun Ju Cho, Se Hyung Kim, Jeong-Hoon Lee, Yoon Jun Kim, Jeong Min Lee, Jae Young Lee, Jung-Hwan Yoon
Biomedicines.2023; 11(2): 382. CrossRef
MRI features of histologic subtypes of hepatocellular carcinoma: correlation with histologic, genetic, and molecular biologic classification
Ja Kyung Yoon, Jin-Young Choi, Hyungjin Rhee, Young Nyun Park
European Radiology.2022; 32(8): 5119. CrossRef
Imaging features of hepatobiliary MRI and the risk of hepatocellular carcinoma development
Jong-In Chang, Dong Hyun Sinn, Woo Kyoung Jeong, Jeong Ah Hwang, Ho Young Won, Kyunga Kim, Wonseok Kang, Geum-Youn Gwak, Yong-Han Paik, Moon Seok Choi, Joon Hyeok Lee, Kwang Cheol Koh, Seung-Woon Paik
Scandinavian Journal of Gastroenterology.2022; 57(12): 1470. CrossRef
Potential of a Non-Contrast-Enhanced Abbreviated MRI Screening Protocol (NC-AMRI) in High-Risk Patients under Surveillance for HCC
François Willemssen, Quido de Lussanet de la Sablonière, Daniel Bos, Jan IJzermans, Robert De Man, Roy Dwarkasing
Cancers.2022; 14(16): 3961. CrossRef
Prognosis of hepatocellular carcinoma patients diagnosed under regular surveillance: potential implications for surveillance goal
Joo Hye Song, Myung Ji Goh, Yewan Park, Joo Hyun Oh, Wonseok Kang, Dong Hyun Sinn, Geum-Youn Gwak, Yong-Han Paik, Moon Seok Choi, Joon Hyeok Lee, Kwang Cheol Koh, Seung Woon Paik
Scandinavian Journal of Gastroenterology.2021; 56(3): 274. CrossRef

Case Report

A Case of Simultaneous Resection of Recurrent Combined Hepatocellular Cholangiocarcinoma and Hypovascular Hepatocellular Carcinoma: Tae Hyung Kim, Soon Ho Um, Sang Jung Park, Seung Woon Park, Han Ah Lee, Yeon Seok Seo, Young Dong Yu, Dong-Sik Kim, Joo Young Kim; J Liver Cancer. 2017;17(1):94-99. Published online March 31, 2017; DOI: https://doi.org/10.17998/jlc.17.1.94

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15 Downloads

Abstract PDF: Liver cancer is more complex to treat compared to cancers in other organs, since liver function should be considered. In addition, only a few patients can be applied curative treatment due to advanced stage at diagnosis. Therefore, early stage detection is important and has been increased through screening and surveillance programs using image modalities recently. However, it is still difficult to diagnose small or hypovascular hepatocellular carcinoma (HCC) even using advanced image modalties. In particular, hypovascular HCCs do not show arterial contrast enhancement which is a typical finding of HCC on computed tomography (CT) and magnetic resonance imaging (MRI). Those also account for a considerable portion of early HCC. We present 54 yearsold man who had recurrent hypervascular and hypovascular nodules on three phase CT and gadoxetic acid-enhanced MRI. The nodules were removed by surgical resection and confirmed as combined hepatocellular-cholangiocarcinoma and well differentiated HCC respectively.

Original Article

Diagnostic Performance of Diffusion-weighted Imaging for Hepatic Neuroendocrine Tumor: Comparison with Combined Diffusion-weighted Imaging and Contrast-enhanced Magnetic Resonance Imaging: Suk Ki Jang, Jung Hoon Kim, Mi Hye Yu, Joon Koo Han; J Liver Cancer. 2016;16(2):92-100. Published online September 30, 2016; DOI: https://doi.org/10.17998/jlc.16.2.92

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12 Downloads

Abstract PDF: Background/Aims
To investigate the diagnostic performance of diffusion-weighted imaging (DWI) for hepatic neuroendocrine tumors (NET) compared with combined DWI and contrastenhanced magnetic resonance imaging (MRI) .
Methods
Fifteen patients with hepatic NET (n=128) underwent enhanced MRI and DWI with multiple-b values. We analyzed three different sets: Precontrast set; DWI set (added DWI); combined set (added enhanced image). Two reviewers rated possibility of NET using a 5-point scale for each image set. Their diagnostic performance was compared using Jackknife alternative free-response ROC (JAFROC).
Results
Diagnostic performance was better on the combined set (figure of merit [FOM]=0.852, 0.761) than the precontrast set (FOM=0.427, 0.572, P<0.05) and the DWI set (FOM=0.682, 0.620, P<0.05). However, DWI improved performance compared with precontrast set without statistical difference. In small NETs (<1 cm), all sets showed low sensitivity (10.7-65.9%) with high specificity (95.4-100%). Interobserver agreement was moderate in all image sets (k=0.521 to 0.589).
Conclusions
Combined DWI and enhanced MRI were more useful for detecting NET. Although statistically insignficant, there was a trend in improved diagnostic performance with DWI.

Case Report

Hemangioma Diagnosed by Gadoxetate Disodium-Enhanced MRI in a Patient with Chronic Hepatitis C: Jin Won Mo, Soo Hyung Ryu, Dong Won Park, Won Jae Yoon, Jin Nam Kim, Jeong Seop Moon, Jae-Chan Shim; J Liver Cancer. 2015;15(1):36-40. Published online March 31, 2015; DOI: https://doi.org/10.17998/jlc.15.1.36

1,439 Views
30 Downloads

Abstract PDF: A hemangioma is the most common benign hepatic tumor. Many hepatic hemangioma tend to be found incidentally, but should be differentiated from malignant tumors, especially in patients with a high risk for malignancy. We presented a 52-year-old woman who diagnosed as hepatic hemangioma. The patient was a chronic alcohol abuser and diagnosed as a hepatic C virus carrier for the first time. Contrast enhanced abdominal computed tomography (CT) revealed a 4cm sized hepatic mass involving both segment 5 and 6. Abdominal CT finding suggested hepatic hemangioma, but could not rule out the malignancy. Because the patient had risk factors for hepatocellular carcinoma, abdominal ultrasonography (US) was performed for further evaluation. But abdominal US also showed atypical finding. For the confirmative diagnosis, dynamic magnetic resonance imaging using gadoxetate disodium (primovist®, Bayer HealthCare, Berlin, Germany) which is the innovative liver cell-specific contrast medium was done, and the patient was diagnosed as hepatic hemangioma.

Original Article

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

1,637 Views
11 Downloads

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 Articles

New Techniques of Ultrasound-guided Radiofrequency Ablation for Hepatocellular Carcinoma: Min Woo Lee; J Liver Cancer. 2014;14(2):89-96. Published online September 30, 2014; DOI: https://doi.org/10.17998/jlc.14.2.89

1,289 Views
11 Downloads

Abstract PDF: In Korea, radiofrequency ablation (RFA) of hepatocellular carcinoma (HCC) is most widely used under ultrasonography (US) guidance. With the technical development, small HCCs in challenging locations can be ablated effectively. Both fusion imaging and contrast-enhanced US is useful for identifying small inconspicuous HCCs on conventional US, thereby enable us to conduct successful RFA. Artificial ascites can enhance ultrasonic window and is helpful in avoiding thermal injury to the surrounding organs. Laparoscopy is also useful for guidance of RFA for subcapsular HCCs which are difficult to approach percutaneously. (J Liver Cancer 2014;14:89-96)

Assessment of Tumor Characteristic with Imaging: Young Kon Kim; Journal of the Korean Liver Cancer Study Group. 2013;13(1):44-47. Published online February 28, 2013; DOI: https://doi.org/10.17998/jlc.13.1.44

1,202 Views
1 Download

Abstract PDF: Magnetic resonance imaging (MRI) has a strongpoint in the detection and characterization of hepatic tumor as it provides multiparametric information. With active implementation of a surveillance program for high-risk hepatocellular carcinoma patients, early hepatocellular carcinoma or cholangiocarcinoma with atypical vascular pattern is being detected with increasing frequency. Therefore, in daily practice, it is challenging to differentiate atypical HCC from dysplastic nodule, hypervascular cholangiocarcinoma and focal nodular hyperplasia-like nodules. Gadoxetic acid and diffusion-weighted imaging has opened new horizons for liver MRI with promising results for liver lesion detection and characterization. Combined both has the potential to be robust liver MR protocol in that it is targeting three processes of hepatic carcinogenesis-hemodynamic changes, hepatocyte function, and tissue diffusivity. In that sense, liver MRI has the potency to fulfill the above two-fold requirement in a more satisfactorily than other liver imaging modalities.

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