Diagnosis of hepatocellular carcinoma

Abstract

Hepatocellular carcinoma (HCC) is one of the commonest cancers worldwide, particularly in parts of the developing world, and is increasing in incidence. This article reviews the current modalities employed for the diagnosis of HCC, including serum markers, radiological techniques and histological evaluation, and summarises international guidelines for the diagnostic approach to HCC.

Figure 1

There is a large HCC in the left lobe of the liver with a pseudocapsule, hyper-enhancing on arterial phase and showing washout on late phases on MR and CEUS and is iso-intense in portal phases on CT and CEUS. The pseudo-capsule enhances in the portal phase on all modalities. A1: T₂ weighted scan showing slightly higher intensity HCC (arrow); A2: T₁ weightted scan shows same HCC which is iso-intense (arrow); B1: MultiHance enhanced T₁ weighted scan in the arterial phase showing enhancement of the HCC (arrow); B2: MultiHance enhanced T₁ weighted scan in the portal phase showing iso-enhancement of the HCC (arrow); B3: MultiHance enhanced T₁ weighted scan at 2 min showing contrast wash-out in the HCC (arrow); B4: MultiHance enhanced T₁ weighted scan at 40 min showing hypoiintense HCC (arrow); C1: Baseline ultrasound shows iso-echoic HCC (arrow); C2: SonoVue enhanced ultrasound shows hyper-enhancing HCC (arrow) in the arterial phase; C3: SonoVue enhanced ultrasound shows iso-enhancing HCC (arrow) in the portal phase with enhancement of the pseudocapsule; C4: SonoVue enhanced ultrasound shows wash-out of the HCC (arrow) in the late phase; D1: Contrast-enhanced CT scan shows enhancement of the HCC (arrow) in the arterial phase; D2: Contrast-enhanced CT scan shows iso-enhancement of the HCC (arrow) in the portal phase with enhancement of the pseudocapsule.