A practical guide for MRI diagnosis of hepatocellular carcinoma: comparison of different guidelines.

Congress:

ECR 2020

Poster Number:

C-14301

Type:

Scientific Exhibit

Keywords:

Not applicable, Cirrhosis, Cancer, Structured reporting, Diagnostic procedure, MR, Oncology, Liver, Abdominal Viscera

Authors:

F. Stallone¹, F. Vernuccio², A. Inzerillo², R. Cannella², G. Porrello², A. Calandra³, G. Brancatelli², M. Midiri²; ¹castelvetrano/IT, ²Palermo/IT, ³PALERMO, Pa/IT

DOI:

10.26044/ecr2020/C-14301

DOI-Link:

https://dx.doi.org/10.26044/ecr2020/C-14301

Fig. 1: Standard MR imaging protocol for HCC diagnosis 75-y.o Male, HBV cirrhosis.

Fig. 2: Hemangioma in a cirrhotic patient. Delayed enhancement assessed with...

Fig. 3: Fig. 3 64-y.o. M, HCV cirrhosis. The lesion is indeterminate by EASL/AASPL, but...

Fig. 4: Top row: Arterial phase hyperenhancement (APHE) and portal venous washout allow...

Purpose

- To provide a practical approach to MRI diagnosis of Hepatocellular Carcinoma (HCC); - To illustrate pros and cons of different International criteria for imaging HCC diagnosis. Background Chronic liver inflammation leads to fibrosis and cyclic cellular process of proliferation and death that may induce genetic alterations in hepatocytes1. Preneoplastic lesions include low-grade dysplastic nodules (LGDN) and high-grade dysplastic nodules (HGDN)2 that may become hepatocellular carcinoma (HCC) in 30% of cases in one to five years3. Conversely, regenerative nodules are not considered preneoplastic. HCC is...

Methods and materials

Diagnostic criteria and imaging techniques for HCC In this educational review we compare four International guidelines/systems for HCC diagnosis in cirrhotic liver: a. European Association for the Study of the Liver (EASL); b. Liver Imaging Reporting and Data System (LI-RADS)/ American Association for the Study of Liver disease; c. Organ Procurement and Transplant Network (OPTN)*; d. Asian Pacific Association for the Study of the Liver (APASL). EASL, LI-RADS and APASL underline the importance of dynamic MRI versus CT imaging in patient at risk (MRI has...

Results

MR Imaging criteria for HCC diagnosis according to multistep carcinogenesis and histology When the process of dedifferentiation occurs in cirrhotic liver, neo angiogenesis leads to an increase of hepatic artery inflow and decrease of portal vein inflow, because of abnormal neo-formed arterial vessels. On MRI these changes lead to arterial phase enhancement of the lesion and washout on portal venous phase. Therefore, according to all the above mentioned guidelines/reporting systems, the typical pattern of HCC is defined by arterial phase hyperenhancement (APHE) and wash out...

Conclusion

HCC is the only solid organ malignancy that can be diagnosed based on imaging criteria only. MRI has a very high diagnostic accuracy for HCC diagnosis and familiarity with protocols, and different imaging criteria for HCC diagnosis is of utmost importance for abdominal radiologists.

Personal information and conflict of interest

F. Stallone; Castelvetrano/IT - nothing to disclose F. Vernuccio; Palermo/IT - nothing to disclose A. Inzerillo; Palermo/IT - nothing to disclose R. Cannella; Palermo/IT - nothing to disclose G. Porrello; Palermo/IT - nothing to disclose A. Calandra; Palermo, PA/IT - nothing to disclose G. Brancatelli; Palermo/IT - nothing to disclose M. Midiri; Palermo/IT - nothing to disclose

References

1Thorgeirsson S, et al. Molecular pathogenesis of human hepatocellular carcinoma. Nat Genet 2002;31:339–46. 2Theise N, et al. Dysplastic nodules and hepatocarcinogenesis. Clin Liv Dis 2002;6:497–512. 3Seki S, et al. Outcomes of dysplastic nodules in human cirrhotic liver: a clinicopathological study. Clin Cancer Res 2000;6:3469–73. 4Parkin DM, et-al. Estimating the world cancer burden: Globocan 2000. Int. J. Cancer. 2001;94 (2): 153-6. Int. J. Cancer (link) - Pubmed citation. 5Semelka RC, et al. Focal hepatic lesions: comparison of dual phase CT and multisequence multiplanar MR imaging including...