The Role of Multimodality Imaging Techniques on Differential Diagnosis of Precancerous Nodules and Hepatocellular Carcinoma

Hui-Jie Jiang, Xiao-Feng Li

Department of Diagnostic Radiology, University of Louisville School of Medicine, Louisville, USA.
Department of Radiology, the Second Affiliated Hospital of Harbin Medical University, Harbin, China.

DOI: 10.4236/ijmpcero.2012.13009                

Abstract

In recent years, the incidence of hepatocellular carcinoma (HCC) has been increasing worldwide, and its high mortality seriously threatens public health. Early detection and treatment are crucial to improving the survival rate. Imaging examination widely used for the diagnosis of HCC and provides a non-invasive means of tumor visualization. The rapid development of medical imaging technology is expected to improve early-stage diagnosis rates for HCC. This article summarizes the methods for the differential diagnosis of premalignant dysplastic nodule (DN) and small hepatocellular carcinoma during the carcinogenesis of cirrhosis and reviews their application. In addition, a discussion on some recently patented medical imaging development was also presented.

Keywords

Precancerous Nodules; Small Hepatocellular Carcinoma; CT; MRI: Ultrasound

Conflicts of Interest

The authors declare no conflicts of interest.

References

[1]	N. D. Theise, “Macroregenerative (Dysplastic) Nodules and Hepatocarcinogenesis: Theoretical and Clinical Considerations,” Seminars in Liver Disease, Vol. 15, No. 4, 1995, pp. 360-371. doi:10.1055/s-2007-1007287
[2]	“Pathologic Diagnosis of Early Hepatocellular Carcinoma: A Report of the International Consensus Group for Hepatocellular Neoplasia,” Hepatology, Vol. 49, No. 2, 2009, pp. 658-664. doi:10.1002/hep.22709
[3]	G. L. Bennett, G. A. Krinsky, R. J. Abitbol, S. Y. Kim, N. D. Theise and L. W. Teperman, “Sonographic Detection of Hepatocellular Carcinoma and Dysplastic Nodules in Cirrhosis: Correlation of Pretransplantation Sonography and Liver Explant Pathology in 200 Patients,” American Journal of Roentgenology, Vol. 179, No.1, 2002, pp. 75-80.
[4]	S. Tanaka, T. Kitamura, M. Fujita, K. Nakanishi and S. Okuda, “Color Doppler Flow Imaging of Liver Tumors,” American Journal of Roentgenology, Vol. 154, No. 3, 1990, pp. 509-514.
[5]	T. Hosoki, M. Mitomo, S. Chor, N. Miyahara, M. Ohtani and K. Morimoto, “Visualization of Tumor Vessels in Hepatocellular Carcinoma. Power Doppler Compared with Color Doppler and Angiography,” Acta Radiologica, Vol. 38, No. 3, 1997, pp. 422-427. doi:10.1080/02841859709172094
[6]	K. Koito, T. Namieno and K. Morita, “Differential Diagnosis of Small Hepatocellular Carcinoma and Adenomatous Hyperplasia with Power Doppler Sonography,” American Journal of Roentgenology, Vol. 170, No. 1, 1998, pp. 157-161.
[7]	V. Catala, C. Nicolau, R. Vilana, M. Pages, L. Bianchi, M. Sanchez and C. Bru, “Characterization of Focal Liver Lesions: Comparative Study of Contrast-Enhanced Ultrasound versus Spiral Computed Tomography,” European Radiology, Vol. 17, No. 4, 2007, pp. 1066-1073. doi:10.1007/s00330-006-0444-6
[8]	R. Li, Y. Guo, X. Hua, Y. He, J. Ding, A. Guo and M. Luo, “Characterization of Focal Liver Lesions: Comparison of Pulse-Inversion Harmonic Contrast-Enhanced Sonography with Contrast-Enhanced CT,” Journal of Clinical Ultrasound, Vol. 35, No. 3, 2007, pp. 109-117. doi:10.1002/jcu.20310
[9]	L.P. Larsen, M. Rosenkilde, H. Christensen, N. Bang, L. Bolvig, T. Christiansen and S. Laurberg, “The Value of Contrast Enhanced Ultrasonography in Detection of Liver Metastases from Colorectal Cancer: A Prospective Double-Blinded Study,” European Journal of Radiology, Vol. 62, No. 2, 2007, pp. 302-307. doi:10.1016/j.ejrad.2006.11.033
[10]	H. J. Jang, T. K. Kim and S. R. Wilson, “Small Nodules (1 - 2 cm) in Liver Cirrhosis: Characterization with Contrast-Enhanced Ultrasound,” European Journal of Radiology, Vol. 72, No. 3, 2009, pp. 418-424. doi:10.1016/j.ejrad.2008.08.011
[11]	M. H. Chen, Y. Dai, K. Yan, Z. H. Fan, S. S. Yin, W. Yang, W. Wu, Y. B. Wang and J. Y. Li, “The Role of Contrast-Enhanced Ultrasound on the Diagnosis of Small Hepatocellular Carcinoma (
[12]	J. F. Xu, H. Y. Liu, Y. Shi, Z. H. Wei and Y. Wu, “Evaluation of Hepatocellular Carcinoma by Contrast-Enhanced Sonography: Correlation with Pathologic Differentiation,” Journal of Ultrasound In Medicine: Official Journal of the American Institute of Ultrasound in Medicine, Vol. 30, No. 5, 2011, pp. 625-633.
[13]	G. J. Liu, H. X. Xu, M. D. Lu, X. Y. Xie, Z. F. Xu, Y. L. Zheng and J. Y. Liang, “Correlation between Enhancement Pattern of Hepatocellular Carcinoma on Real-Time Contrast-Enhanced Ultrasound and Tumour Cellular Differentiation on Histopathology,” The British Journal of Radiology, Vol. 80, No. 953, 2007, pp. 321-330. doi:10.1259/bjr/54805002
[14]	P. Hytiroglou, Y. N. Park, G. Krinsky and N. D. Theise, “Hepatic Precancerous Lesions and Small Hepatocellular Carcinoma,” Gastroenterology Clinics of North America, Vol. 36, No. 4, 2007, pp. 867-887. doi:10.1016/j.gtc.2007.08.010
[15]	M. Kudo, “Hepatocellular Carcinoma 2009 and beyond: From the Surveillance to Molecular Targeted Therapy,” Oncology, Vol. 75, Suppl. 1, 2008, pp. 1-12. doi:10.1159/000181865
[16]	M. Kudo, K. Hatanaka and K. Maekawa, “Newly Developed Novel Ultrasound Technique, Defect Reperfusion Ultrasound Imaging, Using Sonazoid in the Management of Hepatocellular Carcinoma,” Oncology, Vol. 78, Suppl. 1, 2010, pp. 40-45. doi:10.1159/000315229
[17]	V. Salvatore, A. Borghi and F. Piscaglia, “Contrast-Enhanced Ultrasound for Liver Imaging: Recent Advances,” Current Pharmaceutical Design, Vol. 18, No. 15, 2012, pp. 2236-2252. doi:10.2174/138161212800099892
[18]	J. H. Lim, C. K. Kim, W. J. Lee, C. K. Park, K. C. Koh, S. W. Paik and J. W. Joh, “Detection of Hepatocellular Carcinomas and Dysplastic Nodules in Cirrhotic Livers: Accuracy of Helical CT in Transplant Patients,”. American Journal of Roentgenology, Vol. 175, No. 3, 2000, pp. 693-698.
[19]	K. Takayasu, Y. Muramatsu, Y. Mizuguchi and H. Ojima, “CT Imaging of Early Hepatocellular Carcinoma and the Natural Outcome of Hypoattenuating Nodular Lesions in Chronic Liver Disease,” Oncology, Vol. 72, Suppl. 1, 2007, pp. 83-91. doi:10.1159/000111712
[20]	M. Hayashi, O. Matsui, K. Ueda, Y. Kawamori, M. Kadoya, J. Yoshikawa, T. Gabata, T. Takashima, A. Nonomura and Y. Nakanuma, “Correlation between the Blood Supply and Grade of Malignancy of Hepatocellular Nodules Associated with Liver Cirrhosis: Evaluation by CT during Intraarterial Injection of Contrast Medium,” American Journal of Roentgenology, Vol. 172, No. 4, 1999, pp. 969-976.
[21]	P. V. Pandharipande, G. A. Krinsky, H. Rusinek and V. S. Lee, “Perfusion Imaging of the Liver: Current Challenges and Future Goals,” Radiology, Vol. 234, No. 3, 2005, pp. 661-673. doi:10.1148/radiol.2343031362
[22]	Y. Tsushima, S. Funabasama, J. Aoki, S. Sanada and K. Endo, “Quantitative Perfusion Map of Malignant Liver Tumors, Created from Dynamic Computed Tomography Data,” Academic Radiology, Vol. 11, No. 2, 2004, pp. 215-223. doi:10.1016/S1076-6332(03)00578-6
[23]	D.V. Sahani, N.S. Holalkere, P.R. Mueller and A.X. Zhu, “Advanced Hepatocellular Carcinoma: CT Perfusion of Liver and Tumor Tissue—Initial Experience,” Radiology, Vol. 243, No. 3, 2007, pp. 736-743. doi:10.1148/radiol.2433052020
[24]	L. Macarini, P. Milillo, A. Cascavilla, G. Scalzo, L. Stoppino, R. Vinci, G. Moretti and G. Ettorre, “MR Characterisation of Dysplastic Nodules and Hepatocarcinoma in the Cirrhotic Liver with Hepatospecific Superparamagnetic Contrast Agents: Pathological Correlation in Explanted Livers,” La Radiologia Medica, Vol. 114, No. 8, 2009, pp. 1267-1282. doi:10.1007/s11547-009-0464-9
[25]	Y.Y. Jeong, N. Y. Yim and H. K. Kang, “Hepatocellular Carcinoma in the Cirrhotic Liver with Helical CT and MRI: Imaging Spectrum and Pitfalls of Cirrhosis-Related Nodules,” American Journal of Roentgenology, Vol. 185, No. 4, 2005, pp. 1024-1032. doi:10.2214/AJR.04.1096
[26]	C. D. Witjes, F. E. Willemssen, J. Verheij, S. J. van der Veer, B. E. Hansen, C. Verhoef, R. A. de Man and J. N. Ijzermans, “Histological Differentiation Grade and Microvascular Invasion of Hepatocellular Carcinoma Predicted by Dynamic Contrast-Enhanced MRI,” Journal of Magnetic Resonance Imaging, Vol. 36, No. 3, 2012, pp. 641-647. doi:10.1002/jmri.23681
[27]	A. Frydrychowicz, M. G. Lubner, J. J. Brown, E. M. Merkle, S. K. Nagle, N. M. Rofsky and S. B. Reeder, “Hepatobiliary MR Imaging with Gadolinium-Based Contrast Agents,” Journal of magnetic Resonance Imaging, Vol. 35, No. 3, 2012, pp. 492-511. doi:10.1002/jmri.22833
[28]	H. Y. Sun, J. M. Lee, C. I. Shin, D. H. Lee, S. K. Moon, K. W. Kim, J. K. Han and B. I. Choi, “Gadoxetic Acid-Enhanced Magnetic Resonance Imaging for Differentiating Small Hepatocellular Carcinomas (< or =2 cm in Diameter) from Arterial Enhancing Pseudolesions: Special Emphasis on Hepatobiliary Phase Imaging,” Investigative Radiology, Vol. 45, No. 2, 2010, pp. 96-103. doi:10.1097/RLI.0b013e3181c5faf7
[29]	S. S. Ahn, M. J. Kim, J. S. Lim, H. S. Hong, Y. E. Chung and J. Y. Choi, “Added Value of Gadoxetic Acid-Enhanced Hepatobiliary Phase MR Imaging in the Diagnosis of Hepatocellular Carcinoma,” Radiology, Vol. 255, No. 2, 2010, pp. 459-466. doi:10.1148/radiol.10091388
[30]	M. J. Kim, “Current Limitations and Potential Breakroughs for the Early Diagnosis of Hepatocellular Carcima,” Gut and Liver, Vol. 5, No. 1, 2011, pp. 15-21. doi:10.5009/gnl.2011.5.1.15
[31]	M. Kudo, “The 2008 Okuda Lecture: Management of Hepatocellular Carcinoma: From Surveillance to Mocular Targeted Therapy,” Journal of Gastroenterology and Hepatology, Vol. 25, No. 3, 2010, pp. 439-452. doi:10.1111/j.1440-1746.2009.06207.x
[32]	S. A. Lee, C. H. Lee, W. Y. Jung, J. Lee, J. W. Choi, K. A. Kim and C. M. Park, “Paradoxical High Signal Intensity of Hepatocellular Carcinoma in the Hepatobiliary Phase of Gd-EOB-DTPA Enhanced MRI: Initial Experience,” Magnetic Resonance Imaging, Vol. 29, No. 1, 2011, pp. 83-90. doi:10.1016/j.mri.2010.07.019
[33]	S. Shigeru, “Method and Apparatus for Measuring Hepatic Blood Flow Amount,” US Patent No. 6176838, 2001.
[34]	See and R. Jackie, “Methods of Preparing Micro Encapsulated Agents for Use in the Detection of Tumors by CT Imaging,” US Patent No. 6001333, 1999.
[35]	X. H. Hao, J. W. Charboneau, N, J, Hangiandreou and J. F. Greenleaf, “Detection of Tumor Halos in Ultrasound Images,” US Patent No. 6984211, 2006.