Published online Dec 14, 2018. doi: 10.3748/wjg.v24.i46.5215
Peer-review started: August 29, 2018
First decision: October 14, 2018
Revised: October 24, 2018
Accepted: November 2, 2018
Article in press: November 2, 2018
Published online: December 14, 2018
Hepatocellular carcinomas (HCCs) frequently recur despite initial successful surgical resection or local ablation therapy. Diagnostic methods for small HCCs have improved with the introduction of gadoxetic acid-enhanced liver magnetic resonance imaging and diffusion-weighted imaging (DWI). Currently, sub-centimeter recurrent nodules showing typical hallmark imaging findings of HCC are frequently detected in patients with a treatment history for HCC. With five typical magnetic resonance findings, including arterial enhancement, washout on portal or transitional phase, high signal intensity on both T2-weighted image and DWI, and low signal intensity on hepatobiliary phase, sub-centimeter recurrent HCC can be diagnosed with high accuracy. Although more information is needed to determine the treatment of choice, local ablation therapy under fusion imaging and/or contrast-enhanced ultrasound guidance or cone-beam computed tomography-guided chemoembolization seem to be promising as they are effective and safe for the management of sub-centimeter recurrent HCCs.
Core tip: Sub-centimeter recurrent nodules can be diagnosed as hepatocellular carcinomas (HCC) in patients with a history of HCC using five typical magnetic resonance findings, including arterial enhancement, washout on portal or transitional phase, high signal intensity on both T2-weighted image and diffusion-weighted imaging, and low signal intensity on hepatobiliary phase. Local ablation therapy under fusion imaging and/or contrast-enhanced ultrasound guidance or cone-beam computed tomography-guided chemoembolization seems to be promising as they are effective and safe. Further comparative studies are warranted to determine the best treatment options.