Imaging in Hepatocellular Carcinoma: Guidelines and Future Prospects

Background: Non-invasive diagnosis of hepatocellular carcinoma (HCC) in cirrhosis is nowadays the option of choice, as reported by both Western and Eastern guidelines. Methods: Currently, the diagnosis is still focused on the detection of the typical, neoplastic, vascular pattern, characterized by lesion hypervascularization in the arterial phase and by wash-out in the late vascular phase, by means of multidetector computed tomography (MDCT) or magnetic resonance (MR) imaging. In cases of atypical nodules, Western international guidelines suggest, depending on the cases, to perform a second imaging examination, but not contrast-enhanced ultrasound (CEUS), or biopsy tissue sampling. On the contrary, Eastern guidelines have additionally included RES(reticuloendothelial system)-targeted ultrasound or MR examination or hepatobiliary MR imaging for these difficult cases. Results: On the basis of new findings regarding the histological changes occurring in the pathway towards nodular malignancy, new hepatospecific contrast agents are routinely applied in MR studies, allowing to explore cellular metabolic function also in atypical hypoperfused nodules. Conclusions: In the near future, hepatobiliary MR imaging with hepatocyte-selective contrast agents might be considered the best choice to classify preneoplastic, low-risk lesions or atypical nodules with a high potential of malignancy. Schlüsselwörter Leber Zirrhose Diagnose Hepatozelluläres Karzinom, HCC Magnetresonanz, MR