ESR Essentials: diagnosis of hepatocellular carcinoma—practice recommendations by ESGAR

ESR Essentials: diagnosis of hepatocellular carcinoma—practice recommendations by ESGAR

2024 | Roberto Cannella, Marc Zins, Giuseppe Brancatelli
This article provides practice recommendations for the noninvasive diagnosis of hepatocellular carcinoma (HCC) based on current guidelines from EASL, AASLD, KLCA-NCC, and APASL. HCC is the most common primary liver cancer and a leading cause of cancer-related death worldwide. Diagnosis of HCC in high-risk patients can be noninvasive if they have typical imaging features on contrast-enhanced CT, MRI, or ultrasound. Key imaging features include size, non-rim arterial phase hyperenhancement, non-peripheral washout, enhancing capsule, and threshold growth. These features should be combined for a definitive diagnosis. Contrast-enhanced CT or MRI are the first-line imaging exams for HCC diagnosis. MRI is preferred due to its higher sensitivity for small HCCs. CEUS can be used as a problem-solving technique in experienced centers. The LI-RADS algorithm is used to classify lesions based on imaging features. High-risk patients include those with cirrhosis, chronic viral hepatitis B, and a history of HCC. Noninvasive diagnosis is not recommended for noncirrhotic patients without specific risk factors. Imaging features such as non-rim arterial phase hyperenhancement and non-peripheral washout are important for HCC diagnosis. The hepatobiliary phase hypointensity can increase sensitivity but may reduce specificity. Targetoid appearance is not typical for HCC and suggests non-HCC malignancy. Macrovascular invasion is a poor prognostic factor and is diagnosed by the presence of unequivocal enhancing soft tissue in the vein. The diagnosis of HCC should be confirmed by histopathological analysis in patients not meeting high-risk criteria. The article summarizes the essential imaging criteria for HCC diagnosis and discusses the importance of using appropriate imaging modalities and contrast agents based on availability and patient characteristics. The recommendations aim to guide general radiologists in the noninvasive diagnosis of HCC.This article provides practice recommendations for the noninvasive diagnosis of hepatocellular carcinoma (HCC) based on current guidelines from EASL, AASLD, KLCA-NCC, and APASL. HCC is the most common primary liver cancer and a leading cause of cancer-related death worldwide. Diagnosis of HCC in high-risk patients can be noninvasive if they have typical imaging features on contrast-enhanced CT, MRI, or ultrasound. Key imaging features include size, non-rim arterial phase hyperenhancement, non-peripheral washout, enhancing capsule, and threshold growth. These features should be combined for a definitive diagnosis. Contrast-enhanced CT or MRI are the first-line imaging exams for HCC diagnosis. MRI is preferred due to its higher sensitivity for small HCCs. CEUS can be used as a problem-solving technique in experienced centers. The LI-RADS algorithm is used to classify lesions based on imaging features. High-risk patients include those with cirrhosis, chronic viral hepatitis B, and a history of HCC. Noninvasive diagnosis is not recommended for noncirrhotic patients without specific risk factors. Imaging features such as non-rim arterial phase hyperenhancement and non-peripheral washout are important for HCC diagnosis. The hepatobiliary phase hypointensity can increase sensitivity but may reduce specificity. Targetoid appearance is not typical for HCC and suggests non-HCC malignancy. Macrovascular invasion is a poor prognostic factor and is diagnosed by the presence of unequivocal enhancing soft tissue in the vein. The diagnosis of HCC should be confirmed by histopathological analysis in patients not meeting high-risk criteria. The article summarizes the essential imaging criteria for HCC diagnosis and discusses the importance of using appropriate imaging modalities and contrast agents based on availability and patient characteristics. The recommendations aim to guide general radiologists in the noninvasive diagnosis of HCC.
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