In Asian countries favoring loco-regional treatment such as surgical resection or ablation, very early-stage hepatocellular carcinoma (HCC) should be the main target for surveillance. Even though ultrasound (US) has been accepted as a primary imaging modality for HCC surveillance, its performance in detecting very early-stage HCCs is insufficient. Moreover, in more than 20% of patients at high risk for HCC, visualization of the liver on US may be limited owing to the advanced distortion and heterogeneity of the liver parenchyma. Recently revised HCC clinical guidelines allow the use of alternative surveillance tools including computed tomography or magnetic resonance imaging in patients with inadequate US exams. This paper summarizes the findings of recent studies using imaging modalities other than US as surveillance tools for HCC as well as strengths and limitations of these modalities.
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Imaging features of hepatobiliary MRI and the risk of hepatocellular carcinoma development Jong-In Chang, Dong Hyun Sinn, Woo Kyoung Jeong, Jeong Ah Hwang, Ho Young Won, Kyunga Kim, Wonseok Kang, Geum-Youn Gwak, Yong-Han Paik, Moon Seok Choi, Joon Hyeok Lee, Kwang Cheol Koh, Seung-Woon Paik Scandinavian Journal of Gastroenterology.2022; 57(12): 1470. CrossRef
The accurate evaluation of response to treatment is a key aspect in cancer therapy, because an objective response may become
a surrogate marker of improver survival. For cytotoxic drugs, tumor response evaluation according to the World Health
Organization (WHO) criteria or the Response Evaluation Criteria in Solid Tumors (RECIST) guideline offers simple approaches
based on the size of the lesions. However, considering the nature of locoregional therapy or new cytostatic agent for
hepatocellular carcinoma (HCC), which do not decrease the size of the tumor but induce tumor necrosis, original WHO or
RECIST criteria will not reflect clinical benefit exactly. Recently, modified RECIST assessment is proposed by AASLD-JNCI
guidelines. Given that complete necrosis was well correlated with better survival, modified RECIST criteria consider changes in
tumor viability, which can be measured as the area of arterial enhancement, with maintaining overall response assessment similar
to RECIST. The proposed modified RECIST assessment is expected to provide a reliable method for assessing tumor response in
HCC clinical trials.