• 1
    Freeman RB, Mithoefer A, Ruthazer R, Nguyen K, Schore A, Harper A, Edwards E. Optimizing staging for hepatocellular carcinoma before liver transplantation: a retrospective analysis of the UNOS/OPTN database. Liver Transpl 2006; 12: 1504-1511.
  • 2
    Oxford Centre for Evidence-Based Medicine. Levels of evidence (March 2009). Accessed June 2011.
  • 3
    Leoni S, Piscaglia F, Golfieri R, Camaggi V, Vidili G, Pini P, Bolondi L. The impact of vascular and nonvascular findings on the noninvasive diagnosis of small hepatocellular carcinoma based on the EASL and AASLD criteria. Am J Gastroenterol 2010; 105: 599-609.
  • 4
    Levy I, Greig PD, Gallinger S, Langer B, Sherman M. Resection of hepatocellular carcinoma without preoperative tumor biopsy. Ann Surg 2001; 234: 206-209.
  • 5
    Torzilli G, Minagawa M, Takayama T, Inoue K, Hui AM, Kubota K, et al. Accurate preoperative evaluation of liver mass lesions without fine-needle biopsy. Hepatology 1999; 30: 889-893.
  • 6
    Burrel M, Llovet JM, Ayuso C, Iglesias C, Sala M, Miquel R, et al.; for Barcelona Clínic Liver Cancer Group. MRI angiography is superior to helical CT for detection of HCC prior to liver transplantation: an explant correlation. Hepatology 2003; 38: 1034-1042.
  • 7
    Yu JS, Kim KW, Kim EK, Lee JT, Yoo HS. Contrast enhancement of small hepatocellular carcinoma: usefulness of three successive early image acquisitions during multiphase dynamic MR imaging. AJR Am J Roentgenol 1999; 173: 597-604.
  • 8
    Marrero JA, Hussain HK, Nghiem HV, Umar R, Fontana RJ, Lok AS. Improving the prediction of hepatocellular carcinoma in cirrhotic patients with an arterially-enhancing liver mass. Liver Transpl 2005; 11: 281-289.
  • 9
    American Association for the Study of Liver Diseases. Management of hepatocellular carcinoma: an update. Practice Guidelines/HCCUpdate2010.pdf. Accessed June 2011.
  • 10
    Forner A, Vilana R, Ayuso C, Bianchi L, Solé M, Ayuso JR, et al. Diagnosis of hepatic nodules 20 mm or smaller in cirrhosis: prospective validation of the noninvasive diagnostic criteria for hepatocellular carcinoma. Hepatology 2008; 47: 97-104.
  • 11
    Iannaccone R, Laghi A, Catalano C, Rossi P, Mangiapane F, Murakami T, et al. Hepatocellular carcinoma: role of unenhanced and delayed phase multi-detector row helical CT in patients with cirrhosis. Radiology 2005; 234: 460-467.
  • 12
    Oliver JH III, Baron RL, Federle MP, Rockette HE Jr. Detecting hepatocellular carcinoma: value of unenhanced or arterial phase CT imaging or both used in conjunction with conventional portal venous phase contrast-enhanced CT imaging. AJR Am J Roentgenol 1996; 167: 71-77.
  • 13
    Jang HJ, Kim TK, Burns PN, Wilson SR. Enhancement patterns of hepatocellular carcinoma at contrast-enhanced US: comparison with histologic differentiation. Radiology 2007; 244: 898-906.
  • 14
    Willatt JM, Hussain HK, Adusumilli S, Marrero JA. MR imaging of hepatocellular carcinoma in the cirrhotic liver: challenges and controversies. Radiology 2008; 247: 311-330.
  • 15
    Arguedas MR, Chen VK, Eloubeidi MA, Fallon MB. Screening for hepatocellular carcinoma in patients with hepatitis C cirrhosis: a cost-utility analysis. Am J Gastroenterol 2003; 98: 679-690.
    Direct Link:
  • 16
    Lauenstein TC, Salman K, Morreira R, Heffron T, Spivey JR, Martinez E, et al. Gadolinium-enhanced MRI for tumor surveillance before liver transplantation: center-based experience. AJR Am J Roentgenol 2007; 189: 663-670.
  • 17
    Davila JA, Henderson L, Kramer JR, Kanwal F, Richardson PA, Duan Z, El-Serag HB. Utilization of surveillance for hepatocellular carcinoma among hepatitis C virus-infected veterans in the United States. Ann Intern Med 2011; 154: 85-93.
  • 18
    Yang JD, Harmsen WS, Slettedahl SW, Chaiteerakij R, Enders FT, Therneau TM, et al. Factors that affect risk for hepatocellular carcinoma and effects of surveillance. Clin Gastroenterol Hepatol 2011; 9: 617-623.
  • 19
    Tong MJ, Blatt LM, Kao VW. Surveillance for hepatocellular carcinoma in patients with chronic viral hepatitis in the United States of America. J Gastroenterol Hepatol 2001; 16: 553-559.
  • 20
    Davila JA, Morgan RO, Richardson PA, Du XL, McGlynn KA, El-Serag HB. Use of surveillance for hepatocellular carcinoma among patients with cirrhosis in the United States. Hepatology 2010; 52: 132-141.
  • 21
    Andersson KL, Salomon JA, Goldie SJ, Chung RT. Cost effectiveness of alternative surveillance strategies for hepatocellular carcinoma in patients with cirrhosis. Clin Gastroenterol Hepatol 2008; 6: 1418-1424.
  • 22
    Miller WJ, Baron RL, Dodd GD III, Federle MP. Malignancies in patients with cirrhosis: CT sensitivity and specificity in 200 consecutive transplant patients. Radiology 1994; 193: 645-650.
  • 23
    Khalili K, Kim TK, Jang HJ, Haider MA, Khan L, Guindi M, Sherman M. Optimization of imaging diagnosis of 1-2 cm hepatocellular carcinoma: an analysis of diagnostic performance and resource utilization. J Hepatol 2011; 54: 723-728.
  • 24
    Ahn SS, Kim MJ, Lim JS, Hong HS, Chung YE, Choi JY. Added value of gadoxetic acid-enhanced hepatobiliary phase MR imaging in the diagnosis of hepatocellular carcinoma. Radiology 2010; 255: 459-466.
  • 25
    Kim TK, Lee KH, Jang HJ, Haider MA, Jacks LM, Menezes RJ, et al. Analysis of gadobenate dimeglumine-enhanced MR findings for characterizing small (1-2-cm) hepatic nodules in patients at high risk for hepatocellular carcinoma. Radiology 2011; 259: 730-738.
  • 26
    Choi SH, Lee JM, Yu NC, Suh KS, Jang JJ, Kim SH, Choi BI. Hepatocellular carcinoma in liver transplantation candidates: detection with gadobenate dimeglumine-enhanced MRI. AJR Am J Roentgenol 2008; 191: 529-536.
  • 27
    Kim SH, Kim SH, Lee J, Kim MJ, Jeon YH, Park Y, et al. Gadoxetic acid-enhanced MRI versus triple-phase MDCT for the preoperative detection of hepatocellular carcinoma. AJR Am J Roentgenol 2009; 192: 1675-1681.
  • 28
    Di Martino M, Marin D, Guerrisi A, Baski M, Galati F, Rossi M, et al. Intraindividual comparison of gadoxetate disodium-enhanced MR imaging and 64-section multidetector CT in the detection of hepatocellular carcinoma in patients with cirrhosis. Radiology 2010; 256: 806-816.
  • 29
    Xu PJ, Yan FH, Wang JH, Shan Y, Ji Y, Chen CZ. Contribution of diffusion-weighted magnetic resonance imaging in the characterization of hepatocellular carcinomas and dysplastic nodules in cirrhotic liver. J Comput Assist Tomogr 2010; 34: 506-512.
  • 30
    Muhi A, Ichikawa T, Motosugi U, Sano K, Matsuda M, Kitamura T, et al. High-b-value diffusion-weighted MR imaging of hepatocellular lesions: estimation of grade of malignancy of hepatocellular carcinoma. J Magn Reson Imaging 2009; 30: 1005-1011.
  • 31
    Taouli B, Vilgrain V, Dumont E, Daire JL, Fan B, Menu Y. Evaluation of liver diffusion isotropy and characterization of focal hepatic lesions with two single-shot echo-planar MR imaging sequences: prospective study in 66 patients. Radiology 2003; 226: 71-78.
  • 32
    Miller FH, Hammond N, Siddiqi AJ, Shroff S, Khatri G, Wang Y, et al. Utility of diffusion-weighted MRI in distinguishing benign and malignant hepatic lesions. J Magn Reson Imaging 2010; 32: 138-147.
  • 33
    Francis IR, Cohan RH, McNulty NJ, Platt JF, Korobkin M, Gebremariam A, Ragupathi KI. Multidetector CT of the liver and hepatic neoplasms: effect of multiphasic imaging on tumor conspicuity and vascular enhancement. AJR Am J Roentgenol 2003; 180: 1217-1224.
  • 34
    Zhao H, Yao JL, Wang Y, Zhou KR. Detection of small hepatocellular carcinoma: comparison of dynamic enhancement magnetic resonance imaging and multiphase multirow-detector helical CT scanning. World J Gastroenterol 2007; 13: 1252-1256.
  • 35
    Huang JS, Pan HB, Chou CP, Liang HL, Yeh LR, Yang TL, Liu SI. Optimizing scanning phases in detecting small (<2 cm) hepatocellular carcinoma: whole-liver dynamic study with multidetector row CT. J Comput Assist Tomogr 2008; 32: 341-346.
  • 36
    Pomfret EA, Washburn K, Wald C, Nalesnik MA, Douglas D, Russo M, et al. Report of a national conference on liver allocation in patients with hepatocellular carcinoma in the United States. Liver Transpl 2010; 16: 262-278.
  • 37
    Gambarin-Gelwan M, Wolf DC, Shapiro R, Schwartz ME, Min AD. Sensitivity of commonly available screening tests in detecting hepatocellular carcinoma in cirrhotic patients undergoing liver transplantation. Am J Gastroenterol 2000; 95: 1535-1538.
    Direct Link:
  • 38
    Singal A, Volk ML, Waljee A, Salgia R, Higgins P, Rogers MA, Marrero JA. Meta-analysis: surveillance with ultrasound for early-stage hepatocellular carcinoma in patients with cirrhosis. Aliment Pharmacol Ther 2009; 30: 37-47.
  • 39
    Thompson Coon J, Rogers G, Hewson P, Wright D, Anderson R, Jackson S, et al. Surveillance of cirrhosis for hepatocellular carcinoma: a cost-utility analysis. Br J Cancer 2008; 98: 1166-1175.
  • 40
    American College of Radiology. Ultrasound. Accessed June 2011.
  • 41
    Brancatelli G, Baron RL, Peterson MS, Marsh W. Helical CT screening for hepatocellular carcinoma in patients with cirrhosis: frequency and causes of false-positive interpretation. AJR Am J Roentgenol 2003; 180: 1007-1014.
  • 42
    Luca A, Caruso S, Milazzo M, Mamone G, Marrone G, Miraglia R, et al. Multidetector-row computed tomography (MDCT) for the diagnosis of hepatocellular carcinoma in cirrhotic candidates for liver transplantation: prevalence of radiological vascular patterns and histological correlation with liver explants. Eur Radiol 2010; 20: 898-907.
  • 43
    Sangiovanni A, Manini MA, Iavarone M, Romeo R, Forzenigo LV, Fraquelli M, et al. The diagnostic and economic impact of contrast imaging techniques in the diagnosis of small hepatocellular carcinoma in cirrhosis. Gut 2010; 59: 638-644.
  • 44
    Bruix J, Sherman M; for Practice Guidelines Committee, American Association for the Study of Liver Diseases. Management of hepatocellular carcinoma. Hepatology 2005; 42: 1208-1236.
  • 45
    Choi BI, Lee JM. Advancement in HCC imaging: diagnosis, staging and treatment efficacy assessments: imaging diagnosis and staging of hepatocellular carcinoma. J Hepatobiliary Pancreat Sci 2010; 17: 369-373.
  • 46
    Nasu K, Kuroki Y, Tsukamoto T, Nakajima H, Mori K, Minami M. Diffusion-weighted imaging of surgically resected hepatocellular carcinoma: imaging characteristics and relationship among signal intensity, apparent diffusion coefficient, and histopathologic grade. AJR Am J Roentgenol 2009; 193: 438-444.
  • 47
    Nishie A, Tajima T, Ishigami K, Ushijima Y, Okamoto D, Hirakawa M, et al. Detection of hepatocellular carcinoma (HCC) using super paramagnetic iron oxide (SPIO)-enhanced MRI: added value of diffusion-weighted imaging (DWI). J Magn Reson Imaging 2010; 31: 373-382.
  • 48
    De Simone P, Carrai P, Baldoni L, Petruccelli S, Coletti L, Morelli L, Filipponi F. Quality assurance, efficiency indicators and cost-utility of the evaluation workup for liver transplantation. Liver Transpl 2005; 11: 1080-1085.
  • 49
    García-Criado A, Gilabert R, Bargalló X, Brú C. Radiology in liver transplantation. Semin Ultrasound CT MR 2002; 23: 114-129.
  • 50
    Nghiem HV. Imaging of hepatic transplantation. Radiol Clin North Am 1998; 36: 429-443.
  • 51
    Denecke T, Grieser C, Fröling V, Steffen IG, Rudolph B, Stelter L, et al. Multislice computed tomography using a triple-phase contrast protocol for preoperative assessment of hepatic tumor load in patients with hepatocellular carcinoma before liver transplantation. Transpl Int 2009; 22: 395-402.
  • 52
    Lee DH, Kim SH, Lee JM, Park HS, Lee JY, Yi NJ, et al. Diagnostic performance of multidetector row computed tomography, superparamagnetic iron oxide-enhanced magnetic resonance imaging, and dual-contrast magnetic resonance imaging in predicting the appropriateness of a transplant recipient based on Milan criteria: correlation with histopathological findings. Invest Radiol 2009; 44: 311-321.
  • 53
    Kim SH, Choi BI, Lee JY, Kim SJ, So YH, Eun HW, et al. Diagnostic accuracy of multi-/single-detector row CT and contrast-enhanced MRI in the detection of hepatocellular carcinomas meeting the Milan criteria before liver transplantation. Intervirology 2008; 51( suppl 1): 52-60.
  • 54
    Yu NC, Chaudhari V, Raman SS, Lassman C, Tong MJ, Busuttil RW, Lu DS. CT and MRI improve detection of hepatocellular carcinoma, compared with ultrasound alone, in patients with cirrhosis. Clin Gastroenterol Hepatol 2011; 9: 161-167.
  • 55
    Hayashi PH, Trotter JF, Forman L, Kugelmas M, Steinberg T, Russ P, et al. Impact of pretransplant diagnosis of hepatocellular carcinoma on cadveric liver allocation in the era of MELD. Liver Transpl 2004; 10: 42-48.
  • 56
    Reddy MS, Smith L, Jaques BC, Agarwal K, Hudson M, Talbot D, Manas DM. Do laparoscopy and intraoperative ultrasound have a role in the assessment of patients with end-stage liver disease and hepatocellular carcinoma for liver transplantation? Transplant Proc 2007; 39: 1474-1476.
  • 57
    Kim YK, Kim CS, Chung GH, Han YM, Lee SY, Chon SB, Lee JM. Comparison of gadobenate dimeglumine-enhanced dynamic MRI and 16-MDCT for the detection of hepatocellular carcinoma. AJR Am J Roentgenol 2006; 186: 149-157.
  • 58
    Taouli B, Krinsky GA. Diagnostic imaging of hepatocellular carcinoma in patients with cirrhosis before liver transplantation. Liver Transpl 2006; 12( suppl 2): S1-S7.
  • 59
    Colli A, Fraquelli M, Casazza G, Massironi S, Colucci A, Conte D, Duca P. Accuracy of ultrasonography, spiral CT, magnetic resonance, and alpha-fetoprotein in diagnosing hepatocellular carcinoma: a systematic review. Am J Gastroenterol 2006; 101: 513-523.
    Direct Link:
  • 60
    Schroeder T, Ruehm SG. Diagnostic imaging in liver transplantation. Preoperative evaluation and postoperative complications [in German]. Radiologe 2005; 45: 34-43.
  • 61
    Fisher RA, Maroney TP, Fulcher AS, Maluf D, Clay JA, Wolfe LG, et al. Hepatocellular carcinoma: strategy for optimizing surgical resection, transplantation and palliation. Clin Transplant 2002; 16( suppl 7): 52-58.
  • 62
    Bruix J, Sherman M, Llovet JM, Beaugrand M, Lencioni R, Burroughs AK, et al.; for EASL Panel of Experts on HCC. Clinical management of hepatocellular carcinoma. Conclusions of the Barcelona-2000 EASL conference. European Association for the Study of the Liver. J Hepatol 2001; 35: 421-430.
  • 63
    Khan MA, Combs CS, Brunt EM, Lowe VJ, Wolverson MK, Solomon H, et al. Positron emission tomography scanning in the evaluation of hepatocellular carcinoma. J Hepatol 2000; 32: 792-797.
  • 64
    Ho CL, Yu SC, Yeung DW. 11C-acetate PET imaging in hepatocellular carcinoma and other liver masses. J Nucl Med 2003; 44: 213-221.
  • 65
    Ho CL, Chen S, Yeung DW, Cheng TK. Dual-tracer PET/CT imaging in evaluation of metastatic hepatocellular carcinoma. J Nucl Med 2007; 48: 902-909.
  • 66
    Lee JW, Paeng JC, Kang KW, Kwon HW, Suh KS, Chung JK, et al. Prediction of tumor recurrence by 18F-FDG PET in liver transplantation for hepatocellular carcinoma. J Nucl Med 2009; 50: 682-687.
  • 67
    Kornberg A, Freesmeyer M, Bärthel E, Jandt K, Katenkamp K, Steenbeck J, et al. 18F-FDG-uptake of hepatocellular carcinoma on PET predicts microvascular tumor invasion in liver transplant patients. Am J Transplant 2009; 9: 592-600.
  • 68
    Ravaioli M, Grazi GL, Ercolani G, Fiorentino M, Cescon M, Golfieri R, et al. Partial necrosis on hepatocellular carcinoma nodules facilitates tumor recurrence after liver transplantation. Transplantation 2004; 78: 1780-1786.
  • 69
    Lu DS, Yu NC, Raman SS, Limanond P, Lassman C, Murray K, et al. Radiofrequency ablation of hepatocellular carcinoma: treatment success as defined by histologic examination of the explanted liver. Radiology 2005; 234: 954-960.
  • 70
    Kudo M, Kubo S, Takayasu K, Sakamoto M, Tanaka M, Ikai I, et al.; for Liver Cancer Study Group of Japan (Committee for Response Evaluation Criteria in Cancer of the Liver, Liver Cancer Study Group of Japan). Response Evaluation Criteria in Cancer of the Liver (RECICL) proposed by the Liver Cancer Study Group of Japan (2009 revised version). Hepatol Res 2010; 40: 686-692.
  • 71
    Kei SK, Rhim H, Choi D, Lee WJ, Lim HK, Kim YS. Local tumor progression after radiofrequency ablation of liver tumors: analysis of morphologic pattern and site of recurrence. AJR Am J Roentgenol 2008; 190: 1544-1551.
  • 72
    Lencioni R, Llovet JM. Modified RECIST (mRECIST) assessment for hepatocellular carcinoma. Semin Liver Dis 2010; 30: 52-60.
  • 73
    Park MH, Rhim H, Kim YS, Choi D, Lim HK, Lee WJ. Spectrum of CT findings after radiofrequency ablation of hepatic tumors. Radiographics 2008; 28: 379-390.
  • 74
    Lim HK, Choi D, Lee WJ, Kim SH, Lee SJ, Jang HJ, et al. Hepatocellular carcinoma treated with percutaneous radio-frequency ablation: evaluation with follow-up multiphase helical CT. Radiology 2001; 221: 447-454.
  • 75
    Zhang T, Ding X, Wei D, Cheng P, Su X, Liu H, et al. Sorafenib improves the survival of patients with advanced hepatocellular carcinoma: a meta-analysis of randomized trials. Anticancer Drugs 2010; 21: 326-332.
  • 76
    Cheng AL, Kang YK, Chen Z, Tsao CJ, Qin S, Kim JS, et al. Efficacy and safety of sorafenib in patients in the Asia-Pacific region with advanced hepatocellular carcinoma: a phase III randomised, double-blind, placebo-controlled trial. Lancet Oncol 2009; 10: 25-34.
  • 77
    Llovet JM, Ricci S, Mazzaferro V, Hilgard P, Gane E, Blanc JF, et al.; for SHARP Investigators Study Group. Sorafenib in advanced hepatocellular carcinoma. N Engl J Med 2008; 359: 378-390.
  • 78
    Kudo M, Ueshima K. Positioning of a molecular-targeted agent, sorafenib, in the treatment algorithm for hepatocellular carcinoma and implication of many complete remission cases in Japan. Oncology 2010; 78( suppl 1): 154-166.
  • 79
    Horger M, Lauer UM, Schraml C, Berg CP, Koppenhöfer U, Claussen CD, et al. Early MRI response monitoring of patients with advanced hepatocellular carcinoma under treatment with the multikinase inhibitor sorafenib. BMC Cancer 2009; 9: 208.
  • 80
    Hsu CY, Shen YC, Yu CW, Hsu C, Hu FC, Hsu CH, et al. Dynamic contrast-enhanced magnetic resonance imaging biomarkers predict survival and response in hepatocellular carcinoma patients treated with sorafenib and metronomic tegafur/uracil. J Hepatol; doi:10.1016/j.jhep.2011.01.032.
  • 81
    Kim CK, Lim JH, Lee WJ. Detection of hepatocellular carcinomas and dysplastic nodules in cirrhotic liver: accuracy of ultrasonography in transplant patients. J Ultrasound Med 2001; 20: 99-104.
  • 82
    Maluf D, Fisher RA, Maroney T, Cotterell A, Fulcher A, Tisnado J, et al. Non-resective ablation and liver transplantation in patients with cirrhosis and hepatocellular carcinoma (HCC): safety and efficacy. Am J Transplant 2003; 3: 312-317.
  • 83
    Lim JH, Park CK. Hepatocellular carcinoma in advanced liver cirrhosis: CT detection in transplant patients. Abdom Imaging 2004; 29: 203-207.
  • 84
    Kokudo N, Makuuchi M. Evidence-based clinical practice guidelines for hepatocellular carcinoma in Japan: the J-HCC guidelines. J Gastroenterol 2009; 44( suppl 19): 119-121.
  • 85
    Korean Liver Cancer Study Group and National Cancer Center, Korea. Practice guidelines for management of hepatocellular carcinoma 2009 [in Korean]. Korean J Hepatol 2009; 15: 391-423.