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Diagnosis of hepatocellular carcinoma with MRI
  1. Martin H Maurer
  1. Correspondence to Dr Martin H Maurer, Department of Radiology, Inselspital, Bern University Hospital, University of Bern, Bern 3010, Switzerland; martin.maurer{at}insel.ch

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In most cases, hepatocellular carcinoma (HCC) is associated with a known underlying risk factor like chronic viral hepatitis type B and C or alcoholic cirrhosis.1 Patients with chronic liver disease that are at risk for HCC should undergo surveillance ultrasound examinations every 6 months and dynamic cross-sectional imaging like CT and MRI if a detected hepatic nodule exceeds 1 cm in size.2 The established radiological hallmarks for diagnosing HCC non-invasively by imaging—strong contrast uptake in the arterial phase in conjunction with washout in the venous or later phases of dynamic contrast-enhanced studies—as proposed in practice guidelines of different specialised societies (eg, American Association for the Study of the Liver (AASLD) and European Association for the Study of the Liver (EASL) have not been changed for many years.3

Although these imaging features have proven to be very robust with specificities close to 100% even in detecting HCC lesions as small as 1–2 cm in size, their sensitivities continue to be unsatisfactorily low at around 70%.2 4 In this context, comparison of the two cross-sectional imaging modalities MRI and multidetector CT has shown MRI to have a better diagnostic accuracy than CT for detecting HCC.5 An extensive meta-analysis comparing the two imaging modalities on a per-lesion basis showed the sensitivity of MRI for detecting …

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