Imaging of hepatocellular carcinoma: a pilot international survey (original) (raw)
Related papers
Hepatoma Research, 2020
Abstract Imaging plays a notable role in hepatocellular carcinoma (HCC) surveillance, diagnosis, and treatment response assessment. Whereas HCC surveillance among at-risk patients, including those with cirrhosis, has traditionally been ultrasound-based, there are increasing data showing that this strategy is operator-dependent and has insufficient sensitivity when used alone. Several novel blood-based and imaging modalities are currently being evaluated to increase sensitivity for early HCC detection. Multi-phase computed tomography (CT) or contrast-enhanced magnetic resonance imaging (MRI) should be performed in patients with positive surveillance tests to confirm a diagnosis of HCC and perform cancer staging, as needed. HCC is a unique cancer in that most cases can be diagnosed radiographically without histological confirmation when demonstrating characteristic features such as arterial phase hyperenhancement and delayed phase washout. The Liver Imaging Reporting and Data System offers a standardized nomenclature for reporting CT or MRI liver findings among at-risk patients. Finally, cross-sectional imaging plays a critical role for assessing response to any HCC therapy as well as monitoring for HCC recurrence in those who achieve complete response.
Liver Cancer, 2015
Current novel imaging techniques in the diagnosis of hepatocellular carcinoma (HCC), with the latest evidence in this field, was discussed at the Asia-Pacific Primary Liver Cancer Expert (APPLE) meeting held in Taipei, Taiwan, in July 2014. Based on their expertise in a specific area of research, the novel imaging group comprised 12 participants from Japan, South Korea, Taiwan, and China and it included 10 abdominal radiologists, one hepatologist, and one pathologist. The expert participants discussed topics related to HCC imaging that were divided into four categories: (i) detection method, (ii) diagnostic method, (iii) evaluation method, and (iv) functional method. Consensus was reached on 10 statements; specific comments on each statement were provided to explain the rationale for the voting results and to suggest future research directions.
Imaging of Hepatocellular Carcinoma: Practical Guide to Differential Diagnosis
Clinics in Liver Disease, 2011
An estimated 80% to 90% of patients with hepatocellular carcinoma (HCC) in the United States have cirrhosis, 1 with a handful of cases presenting in the noncirrhotic liver. Cirrhosis is characterized by bridging fibrosis and a spectrum of hepatocellular nodules, most of which are benign and regenerative. However, degeneration into dysplastic nodules or HCC can occur through the sequential steps of hepatocarcinogenesis. 2 IMAGING OF HCC The main goals of imaging in HCC are: (1) to make the diagnosis and exclude competing causes; (2) to assess the number and size(s) of tumor(s), which have important implications for medical or surgical therapy, such as liver transplantation; and (3) to locate the masses anatomically and describe the vascular relationships for surgical or interventional treatment planning. The practice guidelines of the American Association for the Study of Liver Diseases (AASLD) include recommendations for periodic surveillance by imaging in patients with cirrhosis. 3 Several imaging modalities are available for the evaluation of hepatocellular carcinoma. The role of each is discussed in this article. Ultrasonography Despite its inherent limitations in evaluating chronic liver disease, routine gray-scale ultrasound (US) is still widely used for the initial evaluation of patients suspected of having liver disease, as well as for HCC screening in patients with known cirrhosis The authors have nothing to disclose.
Imaging Diagnosis and Staging of Hepatocellular Carcinoma
2005
Despite the incremental technological advances in cross-sectional imaging techniques [ultrasound (US), computed tomography (CT), and magnetic resonance imaging (MRI)], there is still some concern that the imaging technology available today is inadequate for appropriate prioritization for liver transplantation (LT) because it cannot provide a sufficiently accurate diagnosis of hepatocellular carcinoma (HCC) on a per-nodule basis or sufficiently accurate disease staging on a per-patient basis. In a recent study, a retrospective analysis of data from the United Network for Organ Sharing (which oversees solid organ transplantation in the United States) compared preoperative findings by cross-sectional imaging with postoperative explant pathology findings; in comparison with the pathological stages of the explanted livers, imaging was found to have underestimated or overestimated the tumor burden in approximately one-fourth of the cases. 1 One might speculate that this finding not only is due to the inherent shortcomings of the cross-sectional imaging techniques that are generally available for the liver but also reflects significant differences in the technical specifications of scanner hardware and software, imaging protocols, and interpretive expertise, the lack of standardization of the language used in imaging reports, and the absence of widely accepted diagnostic criteria. Here we discuss possible pathways to consensus positions on the following issues: 1. The minimal technical requirements for US, CT, and MRI. 2. The minimal requirements for operator expertise. 3. The standardization of imaging reports. 4. The classification of nodules on the imaging workup. 5. The staging of HCC. 6. The standardization of the evaluation of the results of locoregional therapy (LRT). 7. The standardization of surveillance for an early HCC diagnosis in patients listed for LT. MATERIALS AND METHODS We performed a systematic review of the relevant literature and synthesized the available evidence with peer group appraisals and expert reviews. The consensus statements consist of recommendations and scientific comments that are based on a comprehensive review of the literature for each topic. The quality of the existing evidence and the strength of the recommendations have been ranked from 1 (highest) to 5 (lowest) and from A (strongest) to D (weakest), respectively, according to the Oxford evidence-based approach to developing consensus statements.
Iranian Journal of Radiology, 2012
The imaging of hepatocellular carcinoma (HCC) is challenging and plays a crucial role in the diagnosis and staging of the disease. A variety of imaging modalities, such as ultrasound, computed tomography (CT), magnetic resonance imaging (MRI) and nuclear medicine are currently used in evaluating patients with HCC. Although the best option for the treatment of these cases is hepatic resection or transplantation, only 20% of HCCs are surgically treatable. In those patients who are not eligible for surgical treatment, interventional therapies such as transcatheter arterial chemoembolization (TACE), percutaneous ethanol injection (PEI), radio-frequency ablation (RFA), percutaneous microwave coagulation therapy (PMC), laser ablation or cryoablation, and acetic acid injection are indicated. In this paper, we aimed to review the evidence regarding imaging modalities and therapeutic interventions of HCC.
Current staging of hepatocellular carcinoma: imaging implications
Cancer Imaging, 2006
The incidence of hepatocellular carcinoma has been rising in the USA in the past two decades. Hepatocellular carcinoma primarily affects older people and reaches its highest prevalence among those aged between 50 and 70 years. Chronic infection by the hepatitis B virus is the most common cause of this disease. Since hepatocellular carcinoma is an indolent tumor, it has a low life expectancy. In patients with suspected hepatocellular carcinoma, CT, MRI, and ultrasound techniques are useful for formulating the diagnosis based on vascularity and specific enhancement features. In this paper we will discuss the multimodal approach for diagnosis and surveillance of hepatocellular carcinoma. We will also furnish the latest staging and treatment, epidemiology, clinical presentation, pathology and laboratory findings in hepatocellular carcinoma.
Systematic review of radiological imaging for hepatocellular carcinoma in cirrhotic patients
British Journal of Radiology, 2004
We systematically reviewed the evidence for determining the best radiological imaging for characterizing hepatocellular carcinoma (HCC) in cirrhotic patients in 997 articles between 1995 and 2001. We selected only prospective and retrospective cohorts of patients, excluding both case reports and studies without separate data on HCC. Only 29 studies, comprising 918 patients, fulfilled the inclusion criteria: 10 used the explanted liver as the reference standard of diagnosis. All except one, either found no statistically significant difference between imaging modalities or had no direct comparison of sensitivity between different modalities of imaging; 16 studies evaluated HCC among cirrhotic patients and had biopsy or imaging as the reference standard for diagnosis. However, no one imaging technique was shown to be superior. In two studies, data of a HCC subgroup was derived from the studies evaluating different kinds of focal hepatic lesions. No conclusion could be drawn because of the small sample size. One study addressed the issue of therapeutic impact. The evidence for choosing the best modality of imaging for characterizing HCC in cirrhotic patients is inadequate. Large multicentre studies with defined reference standards for diagnosis, and studies evaluating therapeutic impact are needed.
Radiological diagnosis of hepatocellular carcinoma in non-cirrhotic patients
Hepatoma research, 2017
Hepatocellular carcinoma (HCC) arising in non-cirrhotic livers is relatively rare. Compared with HCC arising in cirrhotic livers they have some quirks. HCC in healthy livers are large tumors at diagnosis, and are detected due to the onset of abdominal symptoms, outside of any scheduled monitoring program. In non-cirrhotic patients, HCC has the same appearance as the classic image of cirrhotic HCC substrate. The presence of capsule, extensive intratumoral necrosis and typical behavior in the dynamic study after administration of intravenous contrast are present in most of the non-cirrhotic livers. In the presence of a suspicious lesion of HCC, we must assess the existence of underlying chronic liver disease. Ultrasound, computed tomography, and conventional magnetic resonance are imaging techniques that have a high specificity for the diagnosis of cirrhosis, but exhibit low sensitivity for diagnosis in the early stages of the disease. In recent years, new imaging methods are being developed to assess emerging liver fibrosis. In particular, in patients without chronic liver disease it is imperative to consider the differential diagnosis with other tumors that may settle in healthy livers with similar radiological characteristics as HCC. Therefore, in the presence of a lesion with pathognomonic radiological characteristics of HCC in the absence of cirrhosis, biopsy is required.