Use of Imaging Techniques to Screen Hepatocellular Carcinoma

  • Satoshi GoshimaEmail author
Part of the Current Clinical Oncology book series (CCO)


This chapter is intended to provide a state-of-the art overview of liver imaging with emphasis on the roles of sonography, CT, and MRI in the cirrhotic patient. Fundamentals of using imaging in a surveillance program to monitor the progression of cirrhosis and to detect hepatocellular carcinoma (HCC) are included. Imaging features are discussed that are useful in distinguishing among the various focal lesions that may be found in the cirrhotic liver, including regenerative, dysplastic, and malignant nodules.


Arterial Phase Cirrhotic Liver Portal Venous Phase Dysplastic Nodule Explanted Liver 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.


  1. 1.
    Ohtomo K, Baron RL, Dodd GD 3rd, Federle MP, Miller WJ, Campbell WL, et al. Confluent hepatic fibrosis in advanced cirrhosis: appearance at CT. Radiology. 1993;188(1):31–5.CrossRefPubMedGoogle Scholar
  2. 2.
    Ohtomo K, Baron RL, Dodd GD 3rd, Federle MP, Ohtomo Y, Confer SR. Confluent hepatic fibrosis in advanced cirrhosis: evaluation with MR imaging. Radiology. 1993;189(3):871–4.CrossRefPubMedGoogle Scholar
  3. 3.
    Ozaki K, Matsui O, Gabata T, Kobayashi S, Koda W, Minami T. Confluent hepatic fibrosis in liver cirrhosis: possible relation with middle hepatic venous drainage. Jpn J Radiol. 2013;31(8):530–7.CrossRefPubMedGoogle Scholar
  4. 4.
    Murakami T, Nakamura H, Hori S, Nakanishi K, Mitani T, Tsuda K, et al. CT and MRI of siderotic regenerating nodules in hepatic cirrhosis. J Comput Assist Tomogr. 1992;16(4):578–82.CrossRefPubMedGoogle Scholar
  5. 5.
    Sakamoto M, Hirohashi S, Shimosato Y. Early stages of multistep hepatocarcinogenesis: adenomatous hyperplasia and early hepatocellular carcinoma. Hum Pathol. 1991;22(2):172–8.CrossRefPubMedGoogle Scholar
  6. 6.
    Takayama T, Makuuchi M, Hirohashi S, Sakamoto M, Okazaki N, Takayasu K, et al. Malignant transformation of adenomatous hyperplasia to hepatocellular carcinoma. Lancet. 1990;336(8724):1150–3.CrossRefPubMedGoogle Scholar
  7. 7.
    International Working P. Terminology of nodular hepatocellular lesions. Hepatology. 1995;22(3):983–93.Google Scholar
  8. 8.
    Dodd GD 3rd, Baron RL, Oliver JH 3rd, Federle MP. Spectrum of imaging findings of the liver in end-stage cirrhosis: part II, focal abnormalities. AJR Am J Roentgenol. 1999;173(5):1185–92.CrossRefPubMedGoogle Scholar
  9. 9.
    Krinsky GA, Lee VS, Theise ND, Weinreb JC, Rofsky NM, Diflo T, et al. Hepatocellular carcinoma and dysplastic nodules in patients with cirrhosis: prospective diagnosis with MR imaging and explantation correlation. Radiology. 2001;219(2):445–54.CrossRefPubMedGoogle Scholar
  10. 10.
    Lim JH, Kim CK, Lee WJ, Park CK, Koh KC, Paik SW, et al. Detection of hepatocellular carcinomas and dysplastic nodules in cirrhotic livers: accuracy of helical CT in transplant patients. AJR Am J Roentgenol. 2000;175(3):693–8.CrossRefPubMedGoogle Scholar
  11. 11.
    Kobayashi M, Ikeda K, Hosaka T, Sezaki H, Someya T, Akuta N, et al. Dysplastic nodules frequently develop into hepatocellular carcinoma in patients with chronic viral hepatitis and cirrhosis. Cancer. 2006;106(3):636–47.CrossRefPubMedGoogle Scholar
  12. 12.
    Tanaka S, Kitamra T, Fujita M, Kasugai H, Inoue A, Ishiguro S. Small hepatocellular carcinoma: differentiation from adenomatous hyperplastic nodule with color Doppler flow imaging. Radiology. 1992;182(1):161–5.CrossRefPubMedGoogle Scholar
  13. 13.
    Kudo M, Hatanaka K, Inoue T, Maekawa K. Depiction of portal supply in early hepatocellular carcinoma and dysplastic nodule: value of pure arterial ultrasound imaging in hepatocellular carcinoma. Oncology. 2010;78(Suppl 1):60–7.CrossRefPubMedGoogle Scholar
  14. 14.
    Bennett GL, Krinsky GA, Abitbol RJ, Kim SY, Theise ND, Teperman LW. Sonographic detection of hepatocellular carcinoma and dysplastic nodules in cirrhosis: correlation of pretransplantation sonography and liver explant pathology in 200 patients. AJR Am J Roentgenol. 2002;179(1):75–80.CrossRefPubMedGoogle Scholar
  15. 15.
    Matsui O, Kadoya M, Kameyama T, Yoshikawa J, Takashima T, Nakanuma Y, et al. Benign and malignant nodules in cirrhotic livers: distinction based on blood supply. Radiology. 1991;178(2):493–7.CrossRefPubMedGoogle Scholar
  16. 16.
    Ebara M, Ohto M, Watanabe Y, Kimura K, Saisho H, Tsuchiya Y, et al. Diagnosis of small hepatocellular carcinoma: correlation of MR imaging and tumor histologic studies. Radiology. 1986;159(2):371–7.CrossRefPubMedGoogle Scholar
  17. 17.
    Sano K, Ichikawa T, Motosugi U, Sou H, Muhi AM, Matsuda M, et al. Imaging study of early hepatocellular carcinoma: usefulness of gadoxetic acid-enhanced MR imaging. Radiology. 2011;261(3):834–44.CrossRefPubMedGoogle Scholar
  18. 18.
    Bartolotta TV, Taibbi A, Midiri M, Matranga D, Solbiati L, Lagalla R. Indeterminate focal liver lesions incidentally discovered at gray-scale US: role of contrast-enhanced sonography. Invest Radiol. 2011;46(2):106–15.CrossRefPubMedGoogle Scholar
  19. 19.
    Inoue T, Kudo M, Maenishi O, Komuta M, Nakashima O, Kojiro M, et al. Value of liver parenchymal phase contrast-enhanced sonography to diagnose premalignant and borderline lesions and overt hepatocellular carcinoma. AJR Am J Roentgenol. 2009;192(3):698–705.CrossRefPubMedGoogle Scholar
  20. 20.
    Goshima S, Kanematsu M, Kondo H, Shiratori Y, Onozuka M, Moriyama N, et al. Optimal acquisition delay for dynamic contrast-enhanced MRI of hypervascular hepatocellular carcinoma. AJR Am J Roentgenol. 2009;192(3):686–92.CrossRefPubMedGoogle Scholar
  21. 21.
    Brancatelli G, Federle MP, Blachar A, Grazioli L. Hemangioma in the cirrhotic liver: diagnosis and natural history. Radiology. 2001;219(1):69–74.CrossRefPubMedGoogle Scholar
  22. 22.
    Kim T, Federle MP, Baron RL, Peterson MS, Kawamori Y. Discrimination of small hepatic hemangiomas from hypervascular malignant tumors smaller than 3 cm with three-phase helical CT. Radiology. 2001;219(3):699–706.CrossRefPubMedGoogle Scholar
  23. 23.
    Murakami T, Mochizuki K, Nakamura H. Imaging evaluation of the cirrhotic liver. Semin Liver Dis. 2001;21(2):213–24.CrossRefPubMedGoogle Scholar
  24. 24.
    Mori K, Yoshioka H, Itai Y, Okamoto Y, Mori H, Takahashi N, et al. Arterioportal shunts in cirrhotic patients: evaluation of the difference between tumorous and nontumorous arterioportal shunts on MR imaging with superparamagnetic iron oxide. AJR Am J Roentgenol. 2000;175(6):1659–64.CrossRefPubMedGoogle Scholar
  25. 25.
    Murakami T, Kim T, Takamura M, Hori M, Takahashi S, Federle MP, et al. Hypervascular hepatocellular carcinoma: detection with double arterial phase multi-detector row helical CT. Radiology. 2001;218(3):763–7.CrossRefPubMedGoogle Scholar
  26. 26.
    Itai Y, Matsui O. Blood flow and liver imaging. Radiology. 1997;202(2):306–14.CrossRefPubMedGoogle Scholar
  27. 27.
    Yu JS, Kim KW, Jeong MG, Lee JT, Yoo HS. Nontumorous hepatic arterial-portal venous shunts: MR imaging findings. Radiology. 2000;217(3):750–6.CrossRefPubMedGoogle Scholar
  28. 28.
    Inaba Y, Itai Y, Arai Y, Matsueda K, Yamagami T, Sueyoshi S, et al. Focal attenuation differences in pericystic liver tissue as seen on CT hepatic arteriography and CT arterial portography: observation using a unified helical CT and angiography system. Abdom Imaging. 1999;24(4):360–5.CrossRefPubMedGoogle Scholar
  29. 29.
    Yamagami T, Arai Y, Matsueda K, Inaba Y, Sueyoshi S, Takeuchi Y. The cause of nontumorous defects of portal perfusion in the hepatic hilum revealed by CT during arterial portography. AJR Am J Roentgenol. 1999;172(2):397–402.CrossRefPubMedGoogle Scholar
  30. 30.
    Kanematsu M, Kondo H, Enya M, Yokoyama R, Hoshi H. Nondiseased portal perfusion defects adjacent to the right ribs shown on helical CT during arterial portography. AJR Am J Roentgenol. 1998;171(2):445–8.CrossRefPubMedGoogle Scholar
  31. 31.
    Kadoya M, Matsui O, Takashima T, Nonomura A. Hepatocellular carcinoma: correlation of MR imaging and histopathologic findings. Radiology. 1992;183(3):819–25.CrossRefPubMedGoogle Scholar
  32. 32.
    Beavers KL, Semelka RC. MRI evaluation of the liver. Semin Liver Dis. 2001;21(2):161–77.CrossRefPubMedGoogle Scholar
  33. 33.
    Muhler A, Clement O, Saeed M, Lake JR, Stites DP, Berthezene Y, et al. Gadolinium-ethoxybenzyl-DTPA, a new liver-directed magnetic resonance contrast agent. Absence of acute hepatotoxic, cardiovascular, or immunogenic effects. Invest Radiol. 1993;28(1):26–32.CrossRefPubMedGoogle Scholar
  34. 34.
    Tsuda N, Kato N, Murayama C, Narazaki M, Yokawa T. Potential for differential diagnosis with gadolinium-ethoxybenzyl-diethylenetriamine pentaacetic acid-enhanced magnetic resonance imaging in experimental hepatic tumors. Invest Radiol. 2004;39(2):80–8.CrossRefPubMedGoogle Scholar
  35. 35.
    International Consensus Group for Hepatocellular Neoplasia. Pathologic diagnosis of early hepatocellular carcinoma: a report of the international consensus group for hepatocellular neoplasia. Hepatology. 2009;49(2):658–64.CrossRefGoogle Scholar
  36. 36.
    Addley HC, Griffin N, Shaw AS, Mannelli L, Parker RA, Aitken S, et al. Accuracy of hepatocellular carcinoma detection on multidetector CT in a transplant liver population with explant liver correlation. Clin Radiol. 2011;66(4):349–56.CrossRefPubMedGoogle Scholar
  37. 37.
    Kakihara D, Nishie A, Harada N, Shirabe K, Tajima T, Asayama Y, et al. Performance of gadoxetic acid-enhanced MRI for detecting hepatocellular carcinoma in recipients of living-related-liver-transplantation: comparison with dynamic multidetector row computed tomography and angiography-assisted computed tomography. J Magn Reson Imaging. 2014;40(5):1112–20.CrossRefPubMedGoogle Scholar
  38. 38.
    Arii S, Tobe T. Results of surgical treatment. Follow-up study by liver cancer study group of Japan. In: Tobe T, et al. editors. Primary liver cancer in Japan. Tokyo: Springer; 1992.Google Scholar
  39. 39.
    Achkar JP, Araya V, Baron RL, Marsh JW, Dvorchik I, Rakela J. Undetected hepatocellular carcinoma: clinical features and outcome after liver transplantation. Liver Transpl Surg. 1998;4(6):477–82.CrossRefPubMedGoogle Scholar
  40. 40.
    Mor E, Tur-Kaspa R, Sheiner P, Schwartz M. Treatment of hepatocellular carcinoma associated with cirrhosis in the era of liver transplantation. Ann Intern Med. 1998;129(8):643–53.CrossRefPubMedGoogle Scholar
  41. 41.
    Bruix J, Sherman M, Llovet JM, Beaugrand M, Lencioni R, Burroughs AK, et al. Clinical management of hepatocellular carcinoma. Conclusions of the Barcelona-2000 EASL conference. European Association for the Study of the liver. J Hepatol. 2001;35(3):421–30.CrossRefPubMedGoogle Scholar
  42. 42.
    Collier J, Sherman M. Screening for hepatocellular carcinoma. Hepatology. 1998;27(1):273–8.CrossRefPubMedGoogle Scholar
  43. 43.
    Okuda K. Early recognition of hepatocellular carcinoma. Hepatology. 1986;6(4):729–38.CrossRefPubMedGoogle Scholar
  44. 44.
    Barbara L, Benzi G, Gaiani S, Fusconi F, Zironi G, Siringo S, et al. Natural history of small untreated hepatocellular carcinoma in cirrhosis: a multivariate analysis of prognostic factors of tumor growth rate and patient survival. Hepatology. 1992;16(1):132–7.CrossRefPubMedGoogle Scholar
  45. 45.
    Ebara M, Ohto M, Shinagawa T, Sugiura N, Kimura K, Matsutani S, et al. Natural history of minute hepatocellular carcinoma smaller than three centimeters complicating cirrhosis. A study in 22 patients. Gastroenterology. 1986;90(2):289–98.CrossRefPubMedGoogle Scholar
  46. 46.
    Kudo M, Matsui O, Izumi N, Iijima H, Kadoya M, Imai Y, et al. Surveillance and diagnostic algorithm for hepatocellular carcinoma proposed by the liver cancer study group of Japan: 2014 update. Oncology. 2014;87(Suppl 1):7–21.CrossRefPubMedGoogle Scholar

Copyright information

© Springer International Publishing Switzerland 2016

Authors and Affiliations

  1. 1.Department of RadiologyGifu University HospitalGifuJapan

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