, Volume 8, Issue 1, pp 4-6
Date: 28 Dec 2013

The challenges of novel contrast agents for the imaging diagnosis of hepatocellular carcinoma

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The aim of early detection plans in patients at risk of hepatocellular carcinoma (HCC) is to detect the tumor at an evolutionary phase, when a cure with long-term disease-free survival is highly likely [1]. Accordingly, the goal is to detect and diagnose tumors when they are smaller than 2 cm in size, the so-called BCLC stage 0. Beyond this cut-off, the prevalence of satellites and/or microvascular invasion is significantly increased and treatments such as resection, transplant, and ablation will be plagued by recurrence due to dissemination prior to treatment [1]. While this goal is easy to frame, establishing accurate diagnosis in such small nodules is a major clinical challenge. Tumor markers, including alpha-fetoprotein and novel ones such as glypican or PIVKA, have no major usefulness for screening and diagnosis [1], and thus, as in most other cancer types, diagnosis would require a positive biopsy. Nevertheless, biopsy is known to have a suboptimal sensitivity (around 60–70 %) [1