title: MRI of hepatocellular carcinoma: an update of current practices.
abstract: Hepatocellular carcinoma (HCC) is one of the most common cancers worldwide, and liver transplantation is the optimal treatment for selected patients with HCC and chronic liver disease (CLD). Accurate selection of patients for transplantation is essential to maximize patient outcomes and ensure optimized allocation of donor organs. Magnetic resonance imaging (MRI) is a powerful tool for the detection, characterization, and staging of HCC. In patients with CLD, the MRI findings of an arterial-enhancing mass with subsequent washout and enhancing capsule on delayed interstitial phase images are diagnostic for HCC. Major organizations with oversight for organ donor distribution, such as The Organ Procurement and Transplantation Network (OPTN), accept an imaging diagnosis of HCC, no longer requiring tissue biopsy. In patients that are awaiting transplantation, or are not candidates for liver transplantation, localized therapies such as transarterial chemoembolization and radiofrequency ablation may be offered. MRI can be used to monitor treatment response. The purpose of this review article is to describe the role of imaging methods in the diagnosis, staging, and follow-up of HCC, with particular emphasis on established and evolving MRI techniques employing nonspecific gadolinium chelates, hepatobiliary contrast agents, and diffusion weighted imaging. We also briefly review the recently developed Liver Imaging Reporting and Data System (LI-RADS) formulating a standardized terminology and reporting structure for evaluation of lesions detected in patients with CLD.
authors.affiliation: From the Departments of Medical Imaging University of Arizona College of Medicine, Tucson, Arizona, USA. dmartin@radiology.arizona.edu.
authors.forename: Hina
authors.initials: H
authors.lastname: Arif-Tiwari
authors.forename: Bobby
authors.initials: B
authors.lastname: Kalb
authors.forename: Surya
authors.initials: S
authors.lastname: Chundru
authors.forename: Puneet
authors.initials: P
authors.lastname: Sharma
authors.forename: James
authors.initials: J
authors.lastname: Costello
authors.forename: Rainner W
authors.initials: RW
authors.lastname: Guessner
authors.forename: Diego R
authors.initials: DR
authors.lastname: Martin
mesh_terms: D001706:Biopsy; D006528:Carcinoma, Hepatocellular / Q000098:blood supply / Q000175:diagnosis* / Q000453:epidemiology / Q000473:pathology; D016461:Chemoembolization, Therapeutic; D003287:Contrast Media; D038524:Diffusion Magnetic Resonance Imaging; D005260:Female; D006801:Humans; D008103:Liver Cirrhosis / Q000175:diagnosis; D008107:Liver Diseases / Q000175:diagnosis / Q000000981:diagnostic imaging / Q000473:pathology; D008113:Liver Neoplasms / Q000175:diagnosis* / Q000453:epidemiology / Q000473:pathology / Q000628:therapy; D016031:Liver Transplantation; D008279:Magnetic Resonance Imaging; D008297:Male; D061208:Pulsed Radiofrequency Treatment; D011877:Radionuclide Imaging
chemical_list: D003287:Contrast Media