APASL and AASLD Consensus Guidelines on Imaging Diagnosis of Hepatocellular Carcinoma: A Review

Abstract

Consensus guidelines for radiological diagnosis of hepatocellular carcinoma (HCC) have been drafted by several large international working groups. This article reviews the similarities and differences between the most recent guidelines proposed by the American Association for Study of Liver Diseases and the Asian Pacific Association for the Study of the Liver. Current evidence for the various imaging modalities for diagnosis of HCC and their relevance to the consensus guidelines are reviewed.

Figure 1

HIV positive patient with chronic HBV infection without known liver cirrhosis. By the AASLD and APASL guidelines, this lesion would require further evaluation. CT done prior to the MRI also failed to demonstrate arterial hypervascularity. Note, however, that the lesion showed suspicious features on T2-weighted and DW imaging. The lesion was biopsied percutaneously under ultrasound guidance and showed to represent a well-differentiated HCC.

Figure 2

Patient with chronic HCV infection found to have a 2 cm hypoechoeic nodule on surveillence ultrasound scan. Both CEUS and multiphasic contrast-enhanced MRI were performed.

Figure 3

Chronic HBV patient with known multifocal HCC presumed to be confined to the right lobe, completed one session of TACE. US suggested possible nodule in the left hepatic lobe, but this was occult on multiphasic CT. MRI with standard dose of Gd-EOB-DTPA was performed.