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de Santis et al. Hepatoma Res 2019;5:1 Hepatoma Research
DOI: 10.20517/2394-5079.2018.65

Review Open Access

Diagnostic imaging for hepatocellular carcinoma

Adriano de Santis, Giulia Gallusi

Department of translational and precision Medicine, Sapienza University of Rome, Rome 00185, Italy.

Correspondence to: Dr.Adriano de Santis, Department of translational and precision Medicine, Sapienza University of Rome, Rome
00185, Italy. E-mail: adsdmc@tin.it

How to cite this article: de Santis A, Gallusi G. Diagnostic imaging for hepatocellular carcinoma. Hepatoma Res 2019;5:1.
http://dx.doi.org/10.20517/2394-5079.2018.65

Received: 25 May 2018 First Decision: 1 Aug 2018 Revised: 12 Dec 2018 Accepted: 13 Dec 2018 Published: 8 Jan 2019
Science Editor: Guang-Wen Cao Copy Editor: Cui Yu Production Editor: Huang-Liang Wu

Abstract
Hepatocellular carcinoma (HCC) occurs mostly in individuals with cirrhosis, which is why the guidelines of
the most important scientific societies indicate that these patients are included in surveillance programs
through the repetition of an ultrasound examination every 6 months. The aim is to achieve early identification
of the neoplasia in order to increase the possibility of curative therapies (liver transplantation, surgery or local
ablative therapies) and to increase patient survival. HCC nodules arising in cirrhotic livers show characteristic
angiographic behavior that can be evaluated with dynamic multidetector computed tomography and dynamic
magnetic resonance imaging (MRI). However, the use of these techniques in real life is often hindered by the
lack of uniform terminology in reporting and in the interpretation of the exams reflected in the impossibility of
comparing examinations performed in different centers and/or at different times. Liver Imaging Reporting and
Data System® was created to standardize reporting and data collection of computed tomography and MRI for
HCC. In some cases HCC arises in patients with healthy livers and, although there is evidence that angiographic
behavior is not different from cirrhotic patients in this clinical situation, the guidelines still indicate the execution of
a biopsy. Frequent use of palliative therapeutic techniques such as transarterial chemoembolization, transarterial
radioembolization or administration of antiangiogenic drugs (sorafenib) poses problems of interpretation of the
therapeutic response with repercussions on the subsequent choices that have been attempted to resolve with the
use of stringent criteria such as Modified Response Evaluation Criteria In Solid Tumors.

Keywords: Hepatocellular carcinoma, cirrhosis, ultrasonography, magnetic resonance imaging, multidetector computed
tomography, Liver Imaging Reporting and Data System, Modified Response Evaluation Criteria In Solid Tumors

INTRODUCTION
The diagnosis of hepatocellular carcinoma (HCC) can be addressed in two different clinical settings. A first
context, rarely, is that of the patient with a healthy liver. In this scenario, patients do not undergo routine

© The Author(s) 2019. Open Access This article is licensed under a Creative Commons Attribution 4.0
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