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Castán et al. Hepatoma Res 2017;3:1-17 Hepatoma Research
DOI: 10.20517/2394-5079.2015.62
www.hrjournal.net
Review Open Access

Radiological diagnosis of hepatocellular

carcinoma in non-cirrhotic patients

Alba Castán , Ylenia Navarro , Luis Sarría , Raquel Larrosa , Mario Serradilla , Alejandro Serrablo 2
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1 Department of Radiology, Miguel Servet University Hospital, 50009 Zaragoza, Spain.
2 Division of Hepato-Pancreato-Biliary, Department of Surgery, Miguel Servet University Hospital, 50009 Zaragoza, Spain.
Correspondence to: Dr. Luis Sarría, Department of Radiology, Miguel Servet University Hospital, Paseo Isabel la Católica, 1-3, 50009 Zaragoza, Spain.
E-mail: lsarriao@salud.aragon.es
How to cite this article: Castán A, Navarro Y, Sarría L, Larrosa R, Serradilla M, Serrablo A. Radiological diagnosis of hepatocellular carcinoma in
non-cirrhotic patients. Hepatoma Res 2017;3:1-17.
ABSTRACT

Article history: Hepatocellular carcinoma (HCC) arising in non-cirrhotic livers is relatively rare. Compared
Received: 05-11-2015 with HCC arising in cirrhotic livers they have some quirks. HCC in healthy livers are large
Accepted: 17-10-2016 tumors at diagnosis, and are detected due to the onset of abdominal symptoms, outside of any
Published: 12-01-2017 scheduled monitoring program. In non-cirrhotic patients, HCC has the same appearance as
the classic image of cirrhotic HCC substrate. The presence of capsule, extensive intratumoral
Key words: necrosis and typical behavior in the dynamic study after administration of intravenous contrast
Hepatocellular carcinoma, are present in most of the non-cirrhotic livers. In the presence of a suspicious lesion of HCC,
non-cirrhotic liver, we must assess the existence of underlying chronic liver disease. Ultrasound, computed
ultrasound, tomography, and conventional magnetic resonance are imaging techniques that have a high
elastography, specificity for the diagnosis of cirrhosis, but exhibit low sensitivity for diagnosis in the early
computed tomography, stages of the disease. In recent years, new imaging methods are being developed to assess
magnetic resonance emerging liver fibrosis. In particular, in patients without chronic liver disease it is imperative to
consider the differential diagnosis with other tumors that may settle in healthy livers with similar
radiological characteristics as HCC. Therefore, in the presence of a lesion with pathognomonic
radiological characteristics of HCC in the absence of cirrhosis, biopsy is required.

INTRODUCTION and there was an emergence of about 32,000 new
cases in the United States. [1]
Primary liver cancer is the fifth most common cancer
in men and the ninth most common cancer in women, Up to 90% of primary liver tumors are hepatocellular
assuming the second leading cause of cancer death carcinoma (HCC). HCC has its origin in hepatocytes,
worldwide. Eighty-three percent of new cases occur the predominant cells of the liver parenchyma.
[1]
in developing countries, half of them in China. Its Around 80-90% arises in a cirrhotic liver. The most
incidence has increased in recent decades, especially commonly associated risk factors are chronic
in developed countries. In 2015 in Spain, the infection with hepatitis B virus (HBV) and hepatitis C
incidence was 5.172 cases per 100,000 population virus (HCV). HBV is the most common cause of HCC

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