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Copyright ©The Author(s) 2018. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastroenterol. Jun 14, 2018; 24(22): 2348-2362
Published online Jun 14, 2018. doi: 10.3748/wjg.v24.i22.2348
Noninvasive imaging of hepatocellular carcinoma: From diagnosis to prognosis
Han-Yu Jiang, Jie Chen, Chun-Chao Xia, Li-Kun Cao, Ting Duan, Bin Song
Han-Yu Jiang, Jie Chen, Chun-Chao Xia, Li-Kun Cao, Ting Duan, Bin Song, Department of Radiology, Sichuan University West China Hospital, Chengdu 610041, Sichuan Province, China
Author contributions: Jiang HY and Song B designed the research; Jiang HY and Chen J conducted literature search and analysis; Xia CC, Cao LK and Duan T provided material support; Song B provided funding for the article; Jiang HY and Chen J wrote the paper.
Supported by National Natural Science Foundation of China, No. 81471658; and Science and Technology Support Program of Sichuan Province, No. 2017SZ0003.
Conflict-of-interest statement: All authors declared no potential conflict of interests related to this publication.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Bin Song, MD, Chief Doctor, Professor, Department of Radiology, Sichuan University West China Hospital, No. 37 Guoxue Alley, Chengdu 610041, Sichuan Province, China. anicesong@vip.sina.com.
Telephone: +86-28-85423680
Received: March 27, 2018
Peer-review started: March 27, 2018
First decision: April 11, 2018
Revised: April 18, 2018
Accepted: April 23, 2018
Article in press: May 5, 2018
Published online: June 14, 2018
Processing time: 75 Days and 17.5 Hours
Abstract

Hepatocellular carcinoma (HCC) is the most common primary liver cancer and a major public health problem worldwide. Hepatocarcinogenesis is a complex multistep process at molecular, cellular, and histologic levels with key alterations that can be revealed by noninvasive imaging modalities. Therefore, imaging techniques play pivotal roles in the detection, characterization, staging, surveillance, and prognosis evaluation of HCC. Currently, ultrasound is the first-line imaging modality for screening and surveillance purposes. While based on conclusive enhancement patterns comprising arterial phase hyperenhancement and portal venous and/or delayed phase wash-out, contrast enhanced dynamic computed tomography and magnetic resonance imaging (MRI) are the diagnostic tools for HCC without requirements for histopathologic confirmation. Functional MRI techniques, including diffusion-weighted imaging, MRI with hepatobiliary contrast agents, perfusion imaging, and magnetic resonance elastography, show promise in providing further important information regarding tumor biological behaviors. In addition, evaluation of tumor imaging characteristics, including nodule size, margin, number, vascular invasion, and growth patterns, allows preoperative prediction of tumor microvascular invasion and patient prognosis. Therefore, the aim of this article is to review the current state-of-the-art and recent advances in the comprehensive noninvasive imaging evaluation of HCC. We also provide the basic key concepts of HCC development and an overview of the current practice guidelines.

Keywords: Magnetic resonance imaging; Surveillance; Computed tomography; Staging; Ultrasound; Guidelines; Diagnosis; Hepatocellular carcinoma; Prognosis

Core tip: Noninvasive imaging modalities allow diagnosis, characterization, staging, surveillance, and prognosis evaluation of hepatocellular carcinoma (HCC). Functional magnetic resonance imaging techniques show promise in providing further important information of tumor biological behaviors, and, thus, improve the early detection ability and characterization accuracies for HCC. Development of prediction model comprising serological, imaging, texture, and radiogenomic parameters may facilitate preoperative evaluation of tumor recurrence and patient survival. Here, we reviewed recent advances in imaging techniques for noninvasive HCC assessment, basic key concepts of HCC development, and current practice guidelines for HCC management.