Published online Jan 7, 2016. doi: 10.3748/wjg.v22.i1.205
Peer-review started: June 1, 2015
First decision: July 14, 2015
Revised: August 4, 2015
Accepted: December 1, 2015
Article in press: December 1, 2015
Published online: January 7, 2016
Processing time: 216 Days and 11.2 Hours
Hepatocellular carcinoma (HCC) is the most common primary liver cancer. Imaging is important for establishing a diagnosis of HCC and early diagnosis is imperative as several potentially curative treatments are available when HCC is small. Hepatocarcinogenesis occurs in a stepwise manner on a background of chronic liver disease or cirrhosis wherein multiple genes are altered resulting in a range of cirrhosis-associated nodules. This progression is related to increased cellularity, neovascularity and size of the nodule. An understanding of the stepwise progression may aid in early diagnosis. Dynamic and multiphase contrast-enhanced computed tomography and magnetic resonance imaging still form the cornerstone in the diagnosis of HCC. An overview of the current diagnostic standards of HCC in accordance to the more common practicing guidelines and their differences will be reviewed. Ancillary features contribute to diagnostic confidence and has been incorporated into the more recent Liver Imaging Reporting and Data System. The use of hepatocyte-specific contrast agents is increasing and gradually changing the standard of diagnosis of HCC; the most significant benefit being the lack of uptake in the hepatocyte phase in the earlier stages of HCC progression. An outline of supplementary techniques in the imaging of HCC will also be reviewed.
Core tip: Imaging is important for establishing a diagnosis of hepatocellular carcinoma (HCC) and an understanding of the stepwise progression of hepatocarcinogenesis may aid in early diagnosis. Dynamic and multiphase contrast-enhanced computed tomography and magnetic resonance imaging still form the cornerstone in the diagnosis of HCC. An overview of the current diagnostic standards of HCC in accordance to the more common practicing guidelines and their differences will be reviewed. Various ancillary features, use of hepatocyte-specific contrast agents and supplementary imaging techniques also help to increase diagnostic confidence and will be reviewed.