Problematic lesions in cirrhosis

When reviewing the computed tomography (CT) and magnetic resonance (MR) imaging studies of a cirrhotic liver performed for evaluation of hepatocellular carcinoma (HCC), it is not uncommon to encounter lesions that do not show the features allowing for a confident noninvasive diagnosis of benignity or malignancy.In cirrhosis, lesions may have a different imaging presentation because of architectural distortion of the organ.Perfusional abnormalities, in contrast, may have a focal presentation mimicking a true lesion (i.e., pseudolesion).Moreover, up to 20% of all HCCs and up to 40% of HCCs <2 cm do not show the signature imaging pattern such as arterial-phase hyperenhancement and portal or delayed-phase washout.