An overview of hepatocellular carcinoma with atypical enhancement pattern: Spectrum of imaging findings with pathologic correlation
Background. Hepatocellular carcinoma (HCC) is the most common primary liver tumor occuring mostly as the complication of longstanding cirrhosis. In the setting of cirrhotic liver, the diagnosis of HCC is straightforward when typical imaging finding are present in nodules larger than 1cm. However, due to the complexity of hepatocarcinogenesis not all HCCs present with typical vascular behaviour, consisting of arterial hypervascularity followed by portal-venous washout. Thus, hypervascular HCC without washout, isovascular or even hypovascular HCC can pose diagnostic dilemmas in cirrhotic liver. In such cases, it is important to consider also the appearance of the nodules on diffusion-weighted imaging and hepatobiliary phase. Moreover, other ancillary imaging findings such as the presence of the capsule, fat content, signal intensity on T2-weighted image and others must be evaluated. Therefore, the aim of the present study was to provide an overview of HCCs with atypical enhancement pattern, and focus on their magnetic resonance imaging features.
Conclusions. This overview of the imaging diagnosis of HCC focusses on lesion with atypical vascular enhancement. MR imaging features are highlighted in order to facilitate accurate and timely diagnosis.
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