Advancement in HCC imaging: diagnosis, staging and treatment efficacy assessments

Diagnostic confirmation and assessment of disease extent are crucial for proper management of patients with hepatocellular carcinoma (HCC). Imaging studies play a crucial role in the diagnosis and staging of HCC. The imaging techniques commonly used for the diagnosis of HCC include ultrasound, computed tomography, and magnetic resonance imaging. Currently, improvements in imaging technology make a noninvasive and reliable diagnostic assessment of hepatocellular nodules possible in the cirrhotic liver. Biopsy is infrequently required prior to treatment, and the diagnosis of HCC is strongly dependent on hemodynamic features (arterial hypervascularity and washout in the venous phase) on dynamic imaging. Accurate staging of HCC is important in determining prognosis and in deciding optimal treatment for each patient. In addition, although there is a strong demand for an accurate diagnostic tool to detect smaller tumors, until now, the major challenge for radiologists in imaging cirrhosis is the characterization of small hepatocellular nodules in the cirrhotic liver. Further improvement of imaging technologies including functional imaging such as elastography, perfusion imaging and diffusion imaging, and development of new contrast media will undoubtedly improve the detection and characterization of small tumors. In this article, we present a summary of the most recent information on the diagnosis and staging of HCC.