Radiological diagnosis of hepatocellular carcinoma in non-cirrhotic patients

Abstract

Hepatocellular carcinoma (HCC) arising in non-cirrhotic livers is relatively rare. Compared with HCC arising in cirrhotic livers they have some quirks. HCC in healthy livers are large tumors at diagnosis, and are detected due to the onset of abdominal symptoms, outside of any scheduled monitoring program. In non-cirrhotic patients, HCC has the same appearance as the classic image of cirrhotic HCC substrate. The presence of capsule, extensive intratumoral necrosis and typical behavior in the dynamic study after administration of intravenous contrast are present in most of the non-cirrhotic livers. In the presence of a suspicious lesion of HCC, we must assess the existence of underlying chronic liver disease. Ultrasound, computed tomography, and conventional magnetic resonance are imaging techniques that have a high specificity for the diagnosis of cirrhosis, but exhibit low sensitivity for diagnosis in the early stages of the disease. In recent years, new imaging methods are being developed to assess emerging liver fibrosis. In particular, in patients without chronic liver disease it is imperative to consider the differential diagnosis with other tumors that may settle in healthy livers with similar radiological characteristics as HCC. Therefore, in the presence of a lesion with pathognomonic radiological characteristics of HCC in the absence of cirrhosis, biopsy is required.