Hepatocellular carcinoma with macrovascular invasion: multimodality imaging features for the diagnosis

Özet

Hepatocellular carcinoma (HCC) is frequently associated with macrovascular invasion of the portal vein or hepatic veins in advanced stages. The accurate diagnosis of macrovascular invasionand the differentiation from bland non-tumoral thrombus has significant clinical and management implications, since it narrows the therapeutic options and it represents a mandatory contraindication for liver resection or transplantation. The imaging diagnosis remains particularlychallenging since the imaging features of HCC with macrovascular invasion may be subtle, especially in lesions showing infiltrative appearance. However, each radiologic imaging modality mayprovide findings suggesting the presence of tumor thrombus rather than bland thrombus. Thepurpose of this paper is to review the current guidelines and imaging appearance of HCC withmacrovascular invasion. Knowledge of the most common imaging features of HCC with macrovascular invasion may improve the diagnostic confidence of tumor thrombus in clinical practiceand help to guide patients’ management.