Imaging of Liver Tumors in Patients with Chronic Liver Disease

Imaging techniques have become the accepted mainstay for the assessment of liver lesions in cirrhosis and, thanks to the improvement of their diagnostic capabilities in recent years, have further limited the need to resort to bioptic sampling. Hepatocellular carcinoma (HCC) is the most common cause of de-novo liver nodules in cirrhosis, and its diagnosis relies on noninvasive contrast-enhanced imaging studies. Diagnostic criteria have been extensively validated, and the vascular pattern deemed typical for HCC is an arterial hyperenhancement of the nodule followed by washout in the portal or late phase. This pattern provides a positive predictive value for the diagnosis of HCC of about 97 % in nodules in cirrhosis according to the literature. However, the need for a more precise differentiation from other malignancies arising in cirrhosis, making up the remaining about 3 %, and specifically intrahepatic cholangiocarcinoma, has over time led to changes in the recommendations for the noninvasive diagnosis of HCC in cirrhosis. The present review aims to report recently published interesting studies that have brought new insights into the problem of the characterization and differential diagnosis of liver tumors in chronic liver diseases.