A kind of focal lesions called focal nodular hyperplasia-like nodules (FNH-LNs) was found in liver cirrhosis, especially in alcoholic cirrhosis, which is similar to focal nodular hyperplasia in histology. The imaging features of FNH-LNs show hyperenhancement in arterial phase, hypoenhancement in portal venous phase or delayed phase. FNH-LNs are easily misdiagnosed as hepatocellular carcinoma (HCC). With reviewing the relating articles in China and abroad, this article summarizes the etiology, clinicopathological features and imaging manifestations of FNH-LNs, so as to distinguish FNH-LNs and HCC in cirrhosis and guide selection of treatment.

Clinically, there are still substantial differences between hepatocellular carcinoma (HCC) and non-HCC liver malignancies in terms of risk factors, pathogenesis, biological behaviors, treatment selections, prognosis, and prevention measurement. The liver imaging reporting and data system (LI-RADS) M (LR-M) classification criteria in the contrast-enhanced ultrasound LI-RADS (CEUS LI-RADS) can help differentiate HCC from non-HCC malignancies. This review discussed and summarized recent advancements in differential diagnosis of HCC from non-HCC using the LR-M criteria and speculated future directions in the field, i.e., how CEUS LI-RADS distinguish HCC from intrahepatic cholangiocarcinoma, mixed hepatocellular carcinoma cholangiocarcinoma, and liver metastasized and benign tumors. It also discussed differences between CEUS LI-RADS and CT/MRI LI-RADS in diagnosis of liver neoplasms and Sonazoid Ⓡ modified CEUS LI-RADS in differential diagnosis of HCC from non-HCC.