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.
Citations
Citations to this article as recorded by
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
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
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.
Citations
Citations to this article as recorded by
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
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
Citations to this article as recorded by
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
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.
Citations
Citations to this article as recorded by
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
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.
Citations
Citations to this article as recorded by
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
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.
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.
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
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.
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.
Magnetic resonance (MR) imaging provides exquisite, versatile, and unique soft tissue contrast, which allows for an effective
evaluation of a wide range of liver disorders. A careful selection of imaging strategies can yield a comprehensive assessment of
the liver in a reasonable examination time. Recent advances in MR hardware and software allow for rapid acquisition times that
can reduce many of motion artifacts that previously posed limitations to abdominal MR imaging. The ability to obtain
artifact-free images with sufficient contrast-to-noise ratios across a broad range of techniques is now feasible with rapid scanning.
Recently, the use of 3T in liver imaging allows further improvement in image quality.
Combined hepatocellular-cholangiocarcinoma (HCC-CC) is a rare tumor showing histological evidence of both
hepatocellular and biliary epithelial differentiation. Because of its rarity, there have been few reports about the
imaging findings of this tumor. The CT findings of the combined HCC-CC include well-defined tumor with signs
of malignancy such as hepatic hypervascularity, biliary obstruction, satellite nodules, and lymphadenopathy. Some
portions may show hypoattenuation on arterial phase, whereas other portions show delayed persistent
enhancement. The signal intensity of this tumor on magnetic resonance (MR) imaging is not specific. However,
when the tumor resembles cholangiocarcinoma on gross pathologic exam, it shows peripheral rim-like
enhancement, infiltrative margin, and portal vein invasion in patients with liver cirrhosis. On the other hand, when
the tumor has gross appearance of HCC, imaging findings are not helpful for diagnosis. Cross-sectional imagings
are helpful for predicting the predominant component of the combined HCC-CC and determining the treatment
strategy.