title: Magnetic resonance imaging of the cirrhotic liver: diagnosis of hepatocellular carcinoma and evaluation of response to treatment - Part 1.
abstract: Magnetic resonance imaging (MRI) is the modern gold standard for the noninvasive evaluation of the cirrhotic liver. The combination of arterial phase hyperenhancement and delayed wash-out allows a definitive diagnosis of hepatocellular carcinoma (HCC) in patients with liver cirrhosis or chronic liver disease, without the requirement for confirmatory biopsy. That pattern is highly specific and has been endorsed in Western and Asian diagnostic guidelines. However, the sensitivity of the combination is relatively low for small HCCs. In this two-part review paper, we will address MRI of the cirrhotic liver. In this first part, we provide a brief background on liver cirrhosis and HCC, followed by descriptions of imaging surveillance of liver cirrhosis and the diagnostic performance of the different imaging modalities used in clinical settings. We then describe some of the requirements for the basic MRI technique, as well as the standard MRI protocol, and provide a detailed description of the appearance of various types of hepatocellular nodules encountered in the setting of the carcinogenic pathway in the cirrhotic liver, ranging from regenerative nodules to HCC.
authors.affiliation: Department of Radiology, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA, and Hospital Garcia de Orta, Almada, Portugal.
authors.forename: Miguel
authors.initials: M
authors.lastname: Ramalho
authors.affiliation: Department of Radiology, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA, and Hospital Garcia de Orta, Almada, Portugal.
authors.forename: António P
authors.initials: AP
authors.lastname: Matos
authors.affiliation: Department of Radiology, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA, and King Faisal Specialist Hospital and Research Center, Riyadh, Saudi Arabia.
authors.forename: Mamdoh
authors.initials: M
authors.lastname: AlObaidy
authors.affiliation: Department of Radiology, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA.
authors.forename: Fernanda
authors.initials: F
authors.lastname: Velloni
authors.affiliation: Department of Radiology, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA.
authors.forename: Ersan
authors.initials: E
authors.lastname: Altun
authors.affiliation: Department of Radiology, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA.
authors.forename: Richard C
authors.initials: RC
authors.lastname: Semelka
keywords: Contrast media; Image enhancement; Liver Cirrhosis; Magnetic resonance imaging