Functional imaging: a game changer for biomarker discovery and treatment response among patients with hepatocellular...

Liver cancer, particularly hepatocellular carcinoma (HCC), is a leading cause of cancer-related mortality worldwide. Traditional imaging techniques including CT and MRI provide valuable anatomical data but often overlook the liver's functional heterogeneity, which is crucial for accurate diagnosis and personalized treatment.

This review explores advancements in functional imaging modalities, including contrast-enhanced ultrasound (CEUS), diffusion-weighted imaging (DWI), dynamic contrast-enhanced MRI (DCE-MRI), and PET/CT, which provide detailed insights into tumor biology and treatment response in HCC. CEUS enables real-time assessment of hepatic microvascular perfusion with excellent temporal resolution and without ionizing radiation. DCE-MRI and perfusion CT permit time-resolved quantification of perfusion kinetics and vascular permeability, offering surrogate biomarkers of tumor angiogenesis and treatment response. PET/CT, through tracers captures regional variations in metabolism, reflecting tumor viability and functional reserve.

Collectively, these modalities advance precision imaging by linking physiological and metabolic information to morphologic findings, thereby improving diagnostic accuracy, risk stratification, and therapy monitoring in hepatocellular carcinoma.