APASL and AASLD Consensus Guidelines on Imaging Diagnosis of Hepatocellular Carcinoma: A Review

Figure 1

HIV positive patient with chronic HBV infection without known liver cirrhosis. By the AASLD and APASL guidelines, this lesion would require further evaluation. CT done prior to the MRI also failed to demonstrate arterial hypervascularity. Note, however, that the lesion showed suspicious features on T2-weighted and DW imaging. The lesion was biopsied percutaneously under ultrasound guidance and showed to represent a well-differentiated HCC.

(a) Axial fat-saturated respiratory triggered T2-weighted fast spin echo image (TE 80 msec) shows a mildly hyperintense 1.2 cm lesion (arrow) in segment 4

(b) Axial contrast-enhanced fat-suppressed T1-weighted spoiled gradient recalled echo (LAVA) image of the liver at the same level, taken at 20 seconds following injection of standard dose of intravenous contrast (Dotarem, Guerbet) shows no appreciable enhancement in the expected site of the lesion (arrow)

(c) Axial LAVA image in the delayed phase (180 seconds postinjection) shows the lesion (arrow) as hypointense to the surrounding liver, consistent with washout

(d) On the axial DW image (b = 500 s/mm²), the lesion (arrow) is hyperintense. This was correspondingly hypointense on the ADC map (not shown), consistent with restricted diffusion