Radiological imaging plays a crucial role in the diagnosis of hepatocellular carcinoma (HCC) as the noninvasive diagnosis of HCC in high-risk patients by typical imaging findings alone is widely adopted in major practice guidelines for HCC. While imaging techniques have markedly improved in detecting small liver lesions, they often detect incidental benign liver lesions and non-hepatocellular malignancy that can be misdiagnosed as HCC. The most common mimicker of HCC in cirrhotic liver is nontumorous arterioportal shunts that are seen as focal hypervascular liver lesions on dynamic contrast-enhanced cross-sectional imaging. Rapidly enhancing hemangiomas can be easily misdiagnosed as HCC especially on MR imaging with liver-specific contrast agent. Focal inflammatory liver lesions mimic HCC by demonstrating arterial-phase hypervascularity and subsequent washout on dynamic contrast-enhanced imaging. It is important to recognize the suggestive imaging findings for intrahepatic cholangiocarcinoma (CC) as the management of CC is largely different from that of HCC. There are other benign mimickers of HCC such as angiomyolipomas and focal nodular hyperplasia-like nodules. Recognition of their typical imaging findings can reduce false-positive HCC diagnosis.
Carcinoma, Hepatocellular/*diagnosis/radiography ; Diagnosis, Differential ; Hemangioma/complications/radiography/ultrasonography ; Hepatitis B/complications ; Humans ; Inflammation/radiography/ultrasonography ; Liver/radiography/ultrasonography ; Liver Cirrhosis/complications/radiography ; Liver Neoplasms/*diagnosis/radiography ; Magnetic Resonance Imaging ; Non-alcoholic Fatty Liver Disease/radiography/ultrasonography

No abstract available.
Adult ; Breast Neoplasms/diagnosis ; Carcinoma, Hepatocellular/diagnosis ; Eosinophilia/*diagnosis/radiography ; Eosinophils/immunology/metabolism ; Female ; Humans ; Liver Abscess/*radiography/ultrasonography ; Liver Neoplasms/diagnosis ; Male ; Middle Aged

The role of imaging is crucial for the surveillance, diagnosis, staging and treatment monitoring of hepatocellular carcinoma (HCC). Over the past few years, considerable technical advances were made in imaging of HCCs. New imaging technology, however, has introduced new challenges in our clinical practice. In this article, the current status of clinical imaging techniques for HCC is addressed. The diagnostic performance of imaging techniques in the context of recent clinical guidelines is also presented.
Carcinoma, Hepatocellular/*diagnosis/radiography/ultrasonography ; Contrast Media/chemistry ; Ferric Compounds/chemistry ; Humans ; Iron/chemistry ; Liver Neoplasms/*diagnosis/radiography/ultrasonography ; Magnetic Resonance Imaging ; Meglumine/analogs & derivatives/chemistry ; Organometallic Compounds/chemistry ; Oxides/chemistry ; Tomography, X-Ray Computed

Hepatocellular carcinoma (HCC) is one of the most frequent primary malignancies in the world, and, particularly, it is common in the Far East. In the world, more than one million new cases of HCC are seen each year. The prognosis of patients with HCC is extremely poor with an average survival of about six months following the diagnosis. In order to improve the prognosis of HCC, early diagnosis should be attempted utilizing mass screening methods. Screening of a high-risk population with alpha-fetoprotein (AFP) along with non-invasive medical imaging modalities will lead to early diagnosis of HCC and subsequent improvement of survival. Indeed, recent advances in medical imaging techniques have increased the rate of detection of small HCCs, and such imaging modalities include ultrasonography(US), radionuclide imaging(RNI), computed tomography(CT), magnetic resonance imaging(MRI), and angiography. Each imaging method is reviewed with special emphasis on the early diagnosis of HCC.
Adult ; Aged ; Carcinoma, Hepatocellular/*diagnosis ; Case Report ; Comparative Study ; False Negative Reactions ; Female ; Hepatic Artery/radiography ; Human ; Liver/pathology/radiography/radionuclide imaging ; Liver Neoplasms/*diagnosis ; Magnetic Resonance Imaging ; Male ; Time Factors ; Tomography, X-Ray Computed ; Ultrasonography

No abstract available.
Adenocarcinoma/*diagnosis/pathology ; Aged ; Carcinoma, Hepatocellular/diagnosis ; Humans ; Immunohistochemistry ; Liver Neoplasms/*radiography/secondary/ultrasonography ; Magnetic Resonance Imaging ; Male ; Stomach Neoplasms/*diagnosis/pathology ; Tomography, X-Ray Computed ; alpha-Fetoproteins/analysis

We report on a case of a 57-year-old male who underwent a curative resection for hepatocellular carcinoma (HCC) with histological confirmation of a spontaneously necrotized tumor. Initial serum AFP level was 4,778 ng/mL. A 3.7 cm hyperechoic mass in segment 6 of the liver was observed on ultrasonography and dynamic contrast-enhanced liver MRI showed a 3.7x3.1 cm sized HCC. He was scheduled to undergo curative surgical resection under the clinical diagnosis of an early stage HCC (Barcelona Clinic Liver Cancer stage A). Without treatment, the serum AFP level declined rapidly to 50 ng/mL over five weeks. He underwent curative wedge resection of segment 6 of the liver. Histology revealed complete necrosis of the mass rimmed by inflamed fibrous capsule on a background of HBV-related cirrhosis with infiltration of lymphoplasma cells. Exact pathophysiology underlying this event is unknown. Among the proposed mechanisms of spontaneous neoplastic remission of HCC, circulatory disturbance and activation of host immune response offer the most scientific explanation for the complete histologic necrosis of HCC in the resected mass seen in our patient.
Carcinoma, Hepatocellular/*diagnosis/diagnostic imaging/pathology ; Hepatitis B/complications/diagnosis ; Humans ; Liver/diagnostic imaging/pathology ; Liver Cirrhosis/etiology ; Liver Neoplasms/*diagnosis/diagnostic imaging/pathology ; Magnetic Resonance Imaging ; Male ; Middle Aged ; Necrosis ; Radiography ; Remission, Spontaneous ; Ultrasonography ; alpha-Fetoproteins/analysis

BACKGROUND/AIMS: To determine the value of fusion imaging with contrast-enhanced ultrasonography (CEUS) and computed tomography (CT)/magnetic resonance (MR) images for percutaneous radiofrequency ablation (RFA) of very-early-stage hepatocellular carcinomas (HCCs) that are inconspicuous on fusion imaging with B-mode ultrasound (US) and CT/MR images. METHODS: This retrospective study was approved by our institutional review board and the requirement for informed consent was waived. Fusion imaging with CEUS using Sonazoid contrast agent and CT/MR imaging was performed on HCCs (<2 cm) that were inconspicuous on fusion imaging with B-mode US. We evaluated the number of cases that became conspicuous on fusion imaging with CEUS. Percutaneous RFA was performed under the guidance of fusion imaging with CEUS. Technical success and major complication rates were assessed. RESULTS: In total, 30 patients with 30 HCCs (mean, 1.2 cm; range, 0.6-1.7 cm) were included, among which 25 (83.3%) became conspicuous on fusion imaging with CEUS at the time of the planning US and/or RFA procedure. Of those 25 HCCs, RFA was considered feasible for 23 (92.0%), which were thus treated. The technical success and major complication rates were 91.3% (21/23) and 4.3% (1/23), respectively. CONCLUSIONS: Fusion imaging with CEUS and CT/MR imaging is highly effective for percutaneous RFA of very-early-stage HCCs inconspicuous on fusion imaging with B-mode US and CT/MR imaging.
Adult ; Aged ; Carcinoma, Hepatocellular/*diagnosis/radiography/ultrasonography ; Catheter Ablation ; Contrast Media/diagnostic use ; Female ; Ferric Compounds/diagnostic use ; Humans ; Iron/diagnostic use ; Liver Neoplasms/*diagnosis/radiography/ultrasonography ; Magnetic Resonance Imaging ; Male ; Middle Aged ; Neoplasm Staging ; Oxides/diagnostic use ; Retrospective Studies ; Tomography, X-Ray Computed