Abstract
The diagnosis of hepatocellular carcinoma (HCC) is based on imaging examinations in combination with clinical and laboratory findings.
Nevertheless, especially in the setting of a patient with cirrhosis, the differential diagnosis between small HCC and non-malignant hepatocellular lesions may be very challenging.
One of the key pathologic factors for differential diagnosis that is reflected on imaging is vascular supply to the lesion. In fact, through the multi-step progression from regenerative nodule to overt HCC, development of new arterial vessels may be shown. The arterial neovascularisation is presently considered a fundamental, non-invasive, radiological criterion for the diagnosis of HCC in cirrhosis. Dynamic MR imaging well demonstrates the typical vascular features of overt HCC, at the same way as depicted by other cross-sectional imaging modalities, such as Computed Tomography (CT) and Ultrasound (US).
However, during the development of HCC, significant histological changes take place with or without an evident arterial supply of the nodule. Due to the ability to investigate differences of tissue architecture and stromal components, as well as intracellular content of peculiar molecules such as fat, glycogen, or metal ions, MR is particularly useful in the demonstration of the pathologic changes that occur during carcinogenetic process in liver cirrhosis. HCC may show a variety of MR imaging features that greatly affect the signal on baseline T1-weighted images (T1-w.i.) and T2-weighted images (T2-w.i.), which reflect the variable characteristics of this malignancy. In addition, MRI performed with tissue specific contrast media can give an insight on the “grey area” in which significant intranodular histological changes are already present without an evident arterial supply to the nodule.
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Bartolozzi, C., Battaglia, V., Bozzi, E. (2009). Hepatocellular Carcinoma. In: Gourtsoyiannis, N. (eds) Clinical MRI of the Abdomen. Springer, Berlin, Heidelberg. https://doi.org/10.1007/978-3-540-85689-4_5
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DOI: https://doi.org/10.1007/978-3-540-85689-4_5
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