ABSTRACT
Because recent advances in medical care decrease the mortality rate due to liver cirrhosis
itself, many cirrhotic patients die due to hepatocellular carcinoma. Accordingly,
the role of radiology in the evaluation of the patient with cirrhosis is primarily
to characterize the morphologic manifestations of the disease, evaluate the hepatic
and extrahepatic vasculature, assess the effects of portal hypertension, and detect
hepatic tumors. When the latter are identified, a critical role of imaging technology
is to differentiate hepatocellular carcinoma from other nodular lesions, such as dysplastic
nodules and regenerating nodules.
Screening strategies for patients with cirrhosis have been proposed to facilitate
the detection of small, asymptomatic hepatocellular carcinomas. Dynamic studies using
computed tomography (CT) and magnetic resonance imaging (MRI) are very useful for
the diagnosis of hepatic tumors previously detected by ultrasound, as well as for
screening. In Japan, patients with documented cirrhosis typically undergo serum alpha-fetoprotein
testing and/or PIVKA-II (protein induced by vitamin K absence or antagonist II) measurements
every 2 months, ultrasound every 3 months, and CT or MRI every 6 months. This has
resulted in great success in detecting small hepatocellular carcinomas (less than
2 cm in diameter) and early-stage well-differentiated hepatocellular carcinomas.
KEYWORD
Dysplastic nodule - hepatocellular carcinoma - liver cirrhosis - regenerating nodules
- screening
