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SF 1 - Hepatocellular carcinoma: diagnosis, staging and current guidelines
Abdominal Viscera
Wednesday, February 28, 08:30 - 10:00
Room: E1
Moderator: G. Brancatelli (Palermo/IT)

Chairperson's introduction
G. Brancatelli; Palermo/IT
Learning Objectives

1. To become familiar with the international guidelines for HCC diagnosis.
2. To understand why a standardised report facilitates patient management.
3. To learn about the key concepts of diagnosis of typical and atypical HCC with CT and MRI.


Hepatocellular carcinoma (HCC) is the second leading cause of cancer death worldwide. In this session, the rationale behind the need for screening for HCC will be discussed, and the geographic differences in screening programs will be highlighted. The benefits of using LI-RADS terminology, interpretation, and reporting for both clinical care and research will be presented. Typical and atypical appearance of HCC will be shown, along with common mimickers and useful tips of differentiation of focal hepatic nodules in cirrhotic liver. Finally, the speakers will be exposed to challenging cases in the form of unknown, will share their reasoning with each other, and engage in discussions with the chairperson and the audience.

Diagnosis of HCC, American, Asian and European guidelines: why are they different?
V. Vilgrain; Clichy/FR
Learning Objectives

1. To be aware of the different guidelines in HCC diagnosis.
2. To know the most striking differences.
3. To understand the consequences in patient management.


Hepatocellular carcinoma (HCC) is the most common type of liver cancer, accounting for 80-90% of all cases of liver cancer. It is the fifth most common cancer and the third leading cause of cancer-related deaths around the world. As HCC occurs in 90% of the cases in patients with chronic liver disease, screening is indicated in those patients having compensated cirrhosis. Several guidelines have been implemented to help the practitioner to manage the patients during the screening, when a nodule is detected and to decide the optimal treatment in patients with HCC. Among the HCC guidelines which are the most used: AASLD, EASL, Japanese, Korean, and Asia-Pacific ones, there are common features. All agree : (i) on the noninvasive diagnosis of HCC using contrast-enhanced CT or MR imaging with two hallmarks: hypervascularisation on arterial-phase and wash-out on portal and/or delayed phase in lesions larger than one centimeter; (ii) on the role of liver biopsy when diagnosis cannot be achieved with imaging. Yet they differ in many other issues: stratification according to lesion size, first-line imaging modality, role of hepatobiliary MR contrast agents, and role of contrast-enhanced ultrasound. These differences are explained by the different prevalence of HCC worldwide and the different goals of diagnostic performance (high specificity or high sensitivity).

Diagnosis of HCC, LI-RADS 2017: why we need it?
C. B. Sirlin; San Diego/US
Learning Objectives

1. To understand the need for standardised terminology, interpretation, and reporting for clinical care.
2. To understand the need for standardised terminology, interpretation, and reporting for research.
3. To become familiar with LI-RADS terminology, interpretation, and reporting.


LI-RADS is a comprehensive system for imaging HCC in adults with cirrhosis or other risk factors for HCC. It provides standardized terminology with precise definitions and illustrations for screening and surveillance using US, diagnosis and staging using CT, MRI, and CEUS, and treatment response assessment using CT and MRI. It addresses the entire spectrum of lesions and pseudo lesions encountered in the cirrhotic liver as well as the full range of malignant neoplasms associated with chronic liver disease. This lecture will review LI-RADS terminology, interpretation, and reporting and explain why standardization is needed for clinical care, research, and education.

Atypical appearance of HCC and mimics: how to solve the challenging cases
J. M. Lee; Seoul/KR
Learning Objectives

1. To demonstrate imaging spectrum of hepatocellular carcinoma including typical and atypical appearance.
2. To illustrate common mimickers of hepatocellular carcinoma in cirrhotic liver.
3. To provide useful tips of differentiation of focal hepatic nodules in cirrhotic liver.


Hepatocellular carcinoma (HCC) poses a burden on global health. As HCC typically has a poor prognosis with a 5-year survival rate of only 28.6%, it is of paramount importance to achieve the earliest possible diagnosis of HCC and to recommend the most up-to-date optimal treatment strategy in order to increase the survival rate of patients who develop this disease. HCC is commonly diagnosed using dynamic CT and/or dynamic MRI without histological confirmation, on the basis of a characteristic arterial enhancement and portal venous or delayed phase washout. Indeed, the noninvasive diagnosis of HCC in high-risk patients by typical imaging findings alone is widely adopted in major practice guidelines for HCC. HCC usually presents with typical imaging characteristics but at times can present with a wide spectrum of atypical appearances. Familiarity with unusual presentations and their imaging findings is critical to ensuring prompt, accurate diagnosis and treatment. Moreover, while imaging techniques have markedly improved in detecting small liver lesions, they often detect incidental benign liver lesions and non-hepatocellular malignancy that can be misdiagnosed as HCC. The common mimickers of HCC in the cirrhotic liver include nontumorous arterioportal shunts, rapidly enhancing hemangiomas, intrahepatic mass-forming type cholangiocarcinoma (CC), angiomyolipomas, focal inflammatory liver lesions and focal nodular hyperplasia-like nodules. Among them, it is important to recognize the suggestive imaging findings for intrahepatic CC as the management of CC is largely different from that of HCC. Recognition of the typical imaging findings of common HCC mimickers can reduce false-positive HCC diagnosis.

Panel discussion: At the plateau of the learning curve: how do experts reason?
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