Imaging Hepatocellular Carcinoma

Useful features in the imaging diagnosis of hepatocellular carcinoma include the identification of hypervascularity during the hepatic arterial phase, relative hypo-enhancement during the portal phase, and other features including a mosaic appearance, and portal venous enhancement of the pseudocapsule and internal septa. These characteristics correlate with gross pathology and histology, and can be assessed by the various imaging modalities. Magnetic resonance imaging is the optimal modality for detection and characterization of hepatocellular carcinoma and is the best modality for assessment of response after transarterial chemoembolization. Ultrasound contrast shows promise in increasing the utility of ultrasound for diagnosis and assessment of response. It is also invaluable in directing local ablative therapy. Multidetector technology is also improving the ability of CT to detect and characterize hepatocellular carcinoma. Overlap in imaging patterns with arterioportal shunts and dysplastic nodules still pose difficulties in diagnosis with all modalities, however.