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Cancers
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Imaging of Hepatocellular Carcinomas
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Imaging of Hepatocellular Carcinomas

A special issue of Cancers (ISSN 2072-6694). This special issue belongs to the section "Cancer Causes, Screening and Diagnosis".

Deadline for manuscript submissions: 30 June 2025 | Viewed by 2334

Special Issue Editor

Prof. Dr. Masakatsu Tsurusaki

E-Mail Website
Guest Editor
Department of Radiology, Kindai University Faculty of Medicine, 377-2 Ohnohigashi, Osaka-sayama, Osaka 589-8511, Japan
Interests: hepatobiliary imaging; MR; CT; PET; liver cancer
Special Issues, Collections and Topics in MDPI journals

Special Issue Information

Dear Colleagues,

Currently, radiology imaging plays a pivotal role in diagnosis and patient follow-up in the oncology field. Imaging of hepatocellular carcinomas (HCC) encompasses all types of imaging modalities, including ultrasonography (US), computed tomography (CT), magnetic resonance imaging (MRI), and positron emission tomography (PET). All these techniques contribute to the detection and characterization of HCCs, especially in differential diagnosis for other benign hepatic tumors. An important part of HCC imaging concerns providing anatomical information for preoperative planning. Innovations such as radiomics, artificial intelligence, and quantitative imaging are perfectly integrated with radiology imaging, and scientific research in the oncology field is necessary to explore all the possibilities we need to improve our diagnostic accuracy in tumor diagnosis and characterization. More comprehensive tumor diagnosis will enable dedicated treatment options, such as immunotherapy or target therapy tailored to specific imaging characteristics, to reduce non-responder patients and improve survival.

The aim of this Special Issue is to provide an overview of current imaging of HCC. In particular, it will be focused on state-of-the-art and future developments in imaging of hepatic tumors, techniques for the depiction of early involvement, follow-up, risk stratification, and therapeutic response. We are inviting original research articles, reviews, and perspectives to address some of these challenges for the imaging of HCC.

Prof. Dr. Masakatsu Tsurusaki
Guest Editor

Manuscript Submission Information

Manuscripts should be submitted online at www.mdpi.com by registering and logging in to this website. Once you are registered, click here to go to the submission form. Manuscripts can be submitted until the deadline. All submissions that pass pre-check are peer-reviewed. Accepted papers will be published continuously in the journal (as soon as accepted) and will be listed together on the special issue website. Research articles, review articles as well as communications are invited. For planned papers, a title and short abstract (about 100 words) can be sent to the Editorial Office for announcement on this website.

Submitted manuscripts should not have been published previously, nor be under consideration for publication elsewhere (except conference proceedings papers). All manuscripts are thoroughly refereed through a single-blind peer-review process. A guide for authors and other relevant information for submission of manuscripts is available on the Instructions for Authors page. Cancers is an international peer-reviewed open access semimonthly journal published by MDPI.

Please visit the Instructions for Authors page before submitting a manuscript. The Article Processing Charge (APC) for publication in this open access journal is 2900 CHF (Swiss Francs). Submitted papers should be well formatted and use good English. Authors may use MDPI's English editing service prior to publication or during author revisions.

Keywords

  • computed tomography
  • magnetic resonance imaging
  • Gd-EOB-DTPA
  • PET/CT
  • LI-RADS
  • therapeutic response assessment
  • biomarkers
  • radiomics
  • machine learning/deep learning

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Published Papers (3 papers)

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Research

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14 pages, 4718 KiB  
Article
Distinguishing Hepatocellular Carcinoma from Cirrhotic Regenerative Nodules Using MR Cytometry
by Xiaoyu Jiang, Mary Kay Washington, Manhal J. Izzy, Ming Lu, Xinqiang Yan, Zhongliang Zu, John C. Gore and Junzhong Xu
Cancers 2025, 17(7), 1204; https://doi.org/10.3390/cancers17071204 - 1 Apr 2025
Viewed by 236
Abstract
Background and Objectives: Current guidelines recommend contrast-enhanced CT/MRI as confirmatory imaging tests for diagnosing hepatocellular carcinoma (HCC). However, these modalities are not always able to differentiate HCC from benign/dysplastic nodules that are commonly observed in cirrhotic livers. Consequently, many lesions require either pathological [...] Read more.
Background and Objectives: Current guidelines recommend contrast-enhanced CT/MRI as confirmatory imaging tests for diagnosing hepatocellular carcinoma (HCC). However, these modalities are not always able to differentiate HCC from benign/dysplastic nodules that are commonly observed in cirrhotic livers. Consequently, many lesions require either pathological confirmation via invasive biopsy or surveillance imaging after 3–6 months, which results in delayed diagnosis and treatment. We aimed to develop noninvasive imaging biomarkers of liver cell size and cellularity, using magnetic resonance imaging (MRI), and to assess their utility in identifying HCC. Methods: MR cytometry combines measurements of water diffusion rates over different times corresponding to probing cellular microstructure at different spatial scales. Maps of microstructural properties, such as cell size and cellularity, are derived by fitting voxel values in multiple diffusion-weighted images to a three-compartment (blood, intra-, and extracellular water) model of the MRI signal. This method was validated in two phases: (1) histology-driven simulations, utilizing segmented histological images of different liver pathologies, and (2) ex vivo MR cytometry performed on fixed human liver specimens. Results: Both simulations and ex vivo MR cytometry of fixed human liver specimens demonstrated that HCC exhibits significantly smaller cell sizes and higher cellularities compared to normal liver and cirrhotic regenerative nodules. Conclusion: This study highlights the potential of MR cytometry to differentiate HCC from non-HCC lesions by quantifying cell size and cellularity in liver tissues. Our findings provide a strong foundation for further research into the role of MR cytometry in the noninvasive early diagnosis of HCC. Full article
(This article belongs to the Special Issue Imaging of Hepatocellular Carcinomas)
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11 pages, 1418 KiB  
Article
Immunoscore Predicted by Dynamic Contrast-Enhanced Computed Tomography Can Be a Non-Invasive Biomarker for Immunotherapy Susceptibility of Hepatocellular Carcinoma
by Eisuke Ueshima, Keitaro Sofue, Shohei Komatsu, Nobuaki Ishihara, Masato Komatsu, Akihiro Umeno, Kentaro Nishiuchi, Ryohei Kozuki, Takeru Yamaguchi, Takanori Matsuura, Toshifumi Tada and Takamichi Murakami
Cancers 2025, 17(6), 948; https://doi.org/10.3390/cancers17060948 - 11 Mar 2025
Viewed by 477
Abstract
Background/Objectives: Although immunotherapy is the primary treatment option for intermediate-stage hepatocellular carcinoma (HCC), its efficacy varies. This study aimed to identify non-invasive imaging biomarkers predictive of the immunoscore linked to dynamic contrast-enhanced computed tomography (CECT). Methods: We performed immunohistochemical staining with [...] Read more.
Background/Objectives: Although immunotherapy is the primary treatment option for intermediate-stage hepatocellular carcinoma (HCC), its efficacy varies. This study aimed to identify non-invasive imaging biomarkers predictive of the immunoscore linked to dynamic contrast-enhanced computed tomography (CECT). Methods: We performed immunohistochemical staining with CD3+ and CD8+ antibodies and counted the positive cells in the invasive margin (IM) and central tumor (CT), converting them to an immunoscore of 0 to 4 points. We assessed the dynamic CECT findings obtained from 96 patients who underwent hepatectomy for HCC and evaluated the relationship between dynamic CECT findings and immunoscores. For validation, we assessed the treatment effects on 81 nodules using the Response Evaluation Criteria in Solid Tumors in another cohort of 41 patients who received combined immunotherapy with atezolizumab and bevacizumab (n = 27) and durvalumab and tremelizumab (n = 14). Results: HCCs with peritumoral enhancement in the arterial phase (p < 0.001) and rim APHE (p = 0.009) were associated with the immunoscore in univariate linear regression analysis and peritumoral enhancement in the arterial phase (p = 0.004) in multivariate linear regression analysis. The time to nodular progression in HCCs with peritumoral enhancement in the arterial phase was significantly longer than that in HCCs without this feature (p < 0.001). Conclusions: We identified HCCs with peritumoral enhancement in the arterial phase as a noninvasive imaging biomarker to predict immune-inflamed HCC with a high immunoscore tendency. These HCCs were most likely to respond to combined immunotherapy. Full article
(This article belongs to the Special Issue Imaging of Hepatocellular Carcinomas)
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Review

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15 pages, 2118 KiB  
Review
Radiological Assessment and Therapeutic Evaluation in Hepatocellular Carcinoma: Differentiation and Treatment Response with Japanese Guidelines
by Masakatsu Tsurusaki, Keitaro Sofue, Takamichi Murakami and Noboru Tanigawa
Cancers 2025, 17(1), 101; https://doi.org/10.3390/cancers17010101 - 31 Dec 2024
Viewed by 1099
Abstract
The liver is supplied by a dual blood flow system consisting of the portal vein and hepatic artery. Imaging techniques for diagnosing hepatocellular carcinoma (HCC) have been developed along with blood flow imaging, which visualizes the amount of arterial and portal blood flow. [...] Read more.
The liver is supplied by a dual blood flow system consisting of the portal vein and hepatic artery. Imaging techniques for diagnosing hepatocellular carcinoma (HCC) have been developed along with blood flow imaging, which visualizes the amount of arterial and portal blood flow. The diagnosis of HCC differentiation is important for early-stage liver cancer screening and determination of treatment strategies. Dynamic computed tomography/magnetic resonance imaging (MRI) includes blood flow imaging and MRI with contrast-enhanced ultrasound and liver-specific contrast agents are used in combination. In addition, unlike the Response Evaluation Criteria in Solid Tumors (RECIST) (version 1.1), which is the standard for determining treatment efficacy for solid tumors in general, tumor necrosis is generally considered a treatment effect in HCC, and the modified RECIST and Liver Cancer Direct Effectiveness Criteria (RECICL) are widely used. Familiarity with the definitions, criteria, and potential challenges of the mRECIST and RECICL is essential for their effective application in clinical practice. This review integrates the latest advancements in systemic treatments and imaging techniques, including the role of LI-RADS and updates on molecular-targeted therapies such as regorafenib, supported by some systematic review and meta-analysis. Full article
(This article belongs to the Special Issue Imaging of Hepatocellular Carcinomas)
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