Hepatocellular carcinoma (HCC) is the most common primary liver cancer arising in patients with cirrhosis, and the American Association for the Study of Liver Disease (along with other major international guidelines) recommends surveillance for HCC in patients with cirrhosis who would benefit from early detection of HCC [10,11]. Imaging plays a central role in detection, staging, and treatment guidance for HCC. Surveillance has traditionally been performed with conventional US, followed by contrast-enhanced CT or MRI used for definitive diagnosis and staging of HCC [12,13]. However, there may be an emerging role for MRI-based surveillance in patients whose livers are poorly assessed by US. Contrast-enhanced US (CEUS) is becoming established as an accurate technique for assessment of liver masses, including HCC [14]. Discussion of Procedures by Variant Variant 1: Chronic liver disease. Diagnosis and staging of liver fibrosis. Initial imaging. Patients with chronic liver disease can present with findings of frank cirrhosis and portal hypertension, including jaundice and ascites. However, in many patients, the severity of liver disease is not apparent based on clinical or laboratory findings. In general, imaging can be helpful to confirm the presence of cirrhosis based on morphological aDuke University Medical Center, Durham, North Carolina. bPanel Vice Chair, Northwestern University, Chicago, Illinois. cPanel Chair, Johns Hopkins University School of Medicine, Baltimore, Maryland. dUniversity of Arizona, Banner University Medical Center, Tucson, Arizona. eBaylor University Medical Center, Dallas, Texas; American Association for the Study of Liver Diseases. fMontefiore Medical Center, Bronx, New York. gUMass Medical School, Worcester, Massachusetts. hUniversity of Florida College of Medicine, Gainesville, Florida. iNew York University Medical Center, New York, New York. jStanford University Medical Center, Stanford, California. kUniversity of Alabama Medical Center, Birmingham, Alabama.
Chronic Liver Disease. Hepatocellular carcinoma (HCC) is the most common primary liver cancer arising in patients with cirrhosis, and the American Association for the Study of Liver Disease (along with other major international guidelines) recommends surveillance for HCC in patients with cirrhosis who would benefit from early detection of HCC [10,11]. Imaging plays a central role in detection, staging, and treatment guidance for HCC. Surveillance has traditionally been performed with conventional US, followed by contrast-enhanced CT or MRI used for definitive diagnosis and staging of HCC [12,13]. However, there may be an emerging role for MRI-based surveillance in patients whose livers are poorly assessed by US. Contrast-enhanced US (CEUS) is becoming established as an accurate technique for assessment of liver masses, including HCC [14]. Discussion of Procedures by Variant Variant 1: Chronic liver disease. Diagnosis and staging of liver fibrosis. Initial imaging. Patients with chronic liver disease can present with findings of frank cirrhosis and portal hypertension, including jaundice and ascites. However, in many patients, the severity of liver disease is not apparent based on clinical or laboratory findings. In general, imaging can be helpful to confirm the presence of cirrhosis based on morphological aDuke University Medical Center, Durham, North Carolina. bPanel Vice Chair, Northwestern University, Chicago, Illinois. cPanel Chair, Johns Hopkins University School of Medicine, Baltimore, Maryland. dUniversity of Arizona, Banner University Medical Center, Tucson, Arizona. eBaylor University Medical Center, Dallas, Texas; American Association for the Study of Liver Diseases. fMontefiore Medical Center, Bronx, New York. gUMass Medical School, Worcester, Massachusetts. hUniversity of Florida College of Medicine, Gainesville, Florida. iNew York University Medical Center, New York, New York. jStanford University Medical Center, Stanford, California. kUniversity of Alabama Medical Center, Birmingham, Alabama.