- Multiphasic CT scan of the abdomen with 4 phases (unenhanced, arterial, portal venous, and delayed venous) or contrast-enhanced MRI is recommended to assess extent of intra-hepatic disease, exclude extra-hepatic disease and/or tumour thrombi within the hepatic vein, inferior vena cava or portal vein. The hallmark of an HCC is arterial enhancement followed by washout on venous and/or delayed images
- American Association for the Study of Liver Disease (AASLD) 2010 algorithm for evaluation of liver nodules in a cirrhotic liver:
- Nodules > 1 cm, demonstrating typical imaging characteristics of an HCC (arterial enhancement AND delayed washout) are diagnostic of HCC
- If the nodule does not display typical imaging characteristics, then a biopsy is recommended
- The European Association for the Study of the Liver (EASL) recommends a single imaging modality in experienced, high-volume HCC centres (such as VGH), and both CT and MRI evaluation in other centres
- Nodules less than 1 cm should be followed up with ultrasound imaging q3 months (every 6 months?)
- Additional Work-up
- Chest x-ray or CT scan of the chest and bone scan (if bone-related symptoms) to rule out distant metastases. Baseline AFP
- Blood work to establish Child-Pugh score: total bilirubin, serum albumin, INR
- Hepatitis B, C serologies if not previously done
- Liver function should be assessed by the Child-Turcotte-Pugh score or Model for End-Stage Liver Disease (MELD) score
Child-Turcotte-Pugh classification of liver disease:
