Hepatocellular Carcinoma in Cirrhotic Liver: New Perspectives in Diagnostic Imaging

Hepatocellular carcinoma (HCC) is the second most common cause of cancer-relared death in the world. It incidence is expected to increase in the next decades. It is incrasingly being detected at an earlier stage, owing to the implementation of screening programs and regular follow-up imaging in high risk populations. Thus, it becomes essential to differentiate it from benign or pre-malignant nodules, as it has distinct therapeutic and prognostic implications. More recently, liver-specific contrast agents for magnetic resonance imaging (MRI) have become available, such as gadoxetic acid. They have improved lesion detection and characterization of liver injury, when compared to gadolinium-based contrast agents used in recent decades. The authors present a review of the imaging of hepatic nodules in the cirrhotic liver (regenerative, dysplastic and HCC), emphasizing the role of MRI and new contrast agents in the characterization of HCC and its differentiation from other focal lesions.