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

Figure 2

Patient with chronic HCV infection found to have a 2 cm hypoechoeic nodule on surveillence ultrasound scan. Both CEUS and multiphasic contrast-enhanced MRI were performed.

(a) Axial LAVA image in the arterial phase shows a hypervascular lesion (arrow) in segment 5/6

(b) Axial LAVA image at 3 minute delay shows no significant washout in the expected location (arrow) of the lesion. This would be deemed atypical based on consensus criteria

(c) CEUS (SonoVue, Bracco) demonstrates avid arterial enhancement within the lesion (arrow) at 18 seconds

(d) The lesion showed rapid washout, become mildly hypoechoeic (arrow) to the surrounding liver at 35 seconds, consistent with HCC. CEUS is not considered in the revised AASLD guidelines; by APASL criteria, this satisfies criteria for HCC. Histology confirmed moderately differentiated HCC