Imaging evaluation of the cirrhotic liver

Because recent advances in medical care decrease the mortality rate due to liver cirrhosis itself, many cirrhotic patients die due to hepatocellular carcinoma. Accordingly, the role of radiology in the evaluation of the patient with cirrhosis is primarily to characterize the morphologic manifestations of the disease, evaluate the hepatic and extrahepatic vasculature, assess the effects of portal hypertension, and detect hepatic tumors. When the latter are identified, a critical role of imaging technology is to differentiate hepatocellular carcinoma from other nodular lesions, such as dysplastic nodules and regenerating nodules. Screening strategies for patients with cirrhosis have been proposed to facilitate the detection of small, asymptomatic hepatocellular carcinomas. Dynamic studies using computed tomography (CT) and magnetic resonance imaging (MRI) are very useful for the diagnosis of hepatic tumors previously detected by ultrasound, as well as for screening. In Japan, patients with documented cirrhosis typically undergo serum alpha-fetoprotein testing and/or PIVKA-II (protein induced by vitamin K absence or antagonist II) measurements every 2 months, ultrasound every 3 months, and CT or MRI every 6 months. This has resulted in great success in detecting small hepatocellular carcinomas (less than 2 cm in diameter) and early-stage well-differentiated hepatocellular carcinomas.