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Osho et al. Hepatoma Res 2020;6:55 Hepatoma Research
DOI: 10.20517/2394-5079.2020.42

Review Open Access

Role of imaging in management of hepatocellular
carcinoma: surveillance, diagnosis, and treatment

response

Azeez Osho , Nicole E. Rich *, Amit G. Singal *
2,
1
1,
1 Department of Internal Medicine, UT Southwestern Medical Center, Dallas, TX 75390-8887, USA.
2 Division of Digestive and Liver Diseases, UT Southwestern Medical Center, Dallas, TX 75390-8887, USA.
*These two authors are co-senior authors.
Correspondence to: Dr. Amit G. Singal, Division of Digestive and Liver Diseases, UT Southwestern Medical Center, 5959 Harry
Hines Blvd, POB 1, Suite 420, Dallas, TX 75390-8887, USA. E-mail: amit.singal@utsouthwestern.edu

How to cite this article: Osho A, Rich NE, Singal AG. Role of imaging in management of hepatocellular carcinoma: surveillance,
diagnosis, and treatment response. Hepatoma Res 2020;6:55. http://dx.doi.org/10.20517/2394-5079.2020.42

Received: 21 Apr 2020 First Decision: 28 Jun 2020 Revised: 3 Aug 2020 Accepted: 10 Aug 2020 Published: 27 Aug 2020

Academic Editor: Yuko Kono Copy Editor: Cai-Hong Wang Production Editor: Jing Yu

Received: First Decision: Revised: Accepted: Published:
Abstract
Science Editor: Copy Editor: Production Editor: Jing Yu Imaging plays a notable role in hepatocellular carcinoma (HCC) surveillance, diagnosis, and treatment response
assessment. Whereas HCC surveillance among at-risk patients, including those with cirrhosis, has traditionally
been ultrasound-based, there are increasing data showing that this strategy is operator-dependent and has
insufficient sensitivity when used alone. Several novel blood-based and imaging modalities are currently being
evaluated to increase sensitivity for early HCC detection. Multi-phase computed tomography (CT) or contrast-
enhanced magnetic resonance imaging (MRI) should be performed in patients with positive surveillance tests to
confirm a diagnosis of HCC and perform cancer staging, as needed. HCC is a unique cancer in that most cases can
be diagnosed radiographically without histological confirmation when demonstrating characteristic features such
as arterial phase hyperenhancement and delayed phase washout. The Liver Imaging Reporting and Data System
offers a standardized nomenclature for reporting CT or MRI liver findings among at-risk patients. Finally, cross-
sectional imaging plays a critical role for assessing response to any HCC therapy as well as monitoring for HCC
recurrence in those who achieve complete response.

Keywords: Liver cancer, ultrasound, screening, computed tomography, magnetic resonance imaging, contrast-
enhanced ultrasound, Liver Imaging Reporting and Data System

© The Author(s) 2020. Open Access This article is licensed under a Creative Commons Attribution 4.0
International License (https://creativecommons.org/licenses/by/4.0/), which permits unrestricted use,
sharing, adaptation, distribution and reproduction in any medium or format, for any purpose, even commercially, as long
as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license,
and indicate if changes were made.

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