Hepatocellular Carcinoma

Hepatocellular carcinoma (HCC) most frequently develops in the context of chronic injury from viral hepatitis, alcoholic hepatitis, or nonalcoholic fatty liver disease. While histologic assessment of the degree of differentiation is prognostic, the diagnosis of HCC may be made at imaging without histologic confirmation. Ultrasound is typically used for HCC surveillance, and multiphasic contrast-enhanced CT or MRI is used for confirmation and posttreatment follow-up. Major imaging features of HCC include arterial phase hyperenhancement, portal phase washout, capsule appearance, and evidence of growth between imaging exams. Several imaging scoring systems for the noninvasive diagnosis of HCC exist, such as LI-RADS and OPTN/UNOS. Treatment options for HCC include liver transplantation, surgical resection, local thermal ablation, locoregional therapies such as transarterial embolization and external beam radiation, and systemic therapies.