Ultrasound, CT scan, and MRI may be used to evaluate the liver for HCC.
On CT and MRI, HCC can have three distinct patterns of growth:
A single large tumor
Multiple tumors
Poorly defined tumor with an infiltrative growth pattern
A systematic review of CT diagnosis found that the sensitivity was 68% (95% CI 55–80%) and specificity was 93% (95% CI 89–96%) compared with pathologic examination of an explanted or resected liver as the reference standard.
With triple-phase helical CT, the sensitivity was 90% or higher, but these data have not been confirmed with autopsy studies.

However, MRI has the advantage of delivering high-resolution images of the liver without ionizing radiation.
HCC appears as a high-intensity pattern on T2-weighted images and a low-intensity pattern on T1-weighted images.
The advantage of MRI is that it has improved sensitivity and specificity when compared to ultrasound and CT in cirrhotic patients with whom it can be difficult to differentiate HCC from regenerative nodules.
A systematic review found that the sensitivity was 81% (95% CI 70–91%) and specificity was 85% (95% CI 77–93%) compared with pathologic examination of an explanted or resected liver as the reference standard.
The sensitivity is further increased if gadolinium contrast-enhanced and diffusion-weighted imaging are combined.

MRI is more sensitive and specific than CT.

Liver image reporting and data system (LI-RADS) is a classification system for the reporting of liver lesions detected on CT and MRI.
Radiologists use this standardized system to report on suspicious lesions and to provide an estimated likelihood of malignancy.
Categories range from LI-RADS (LR) 1 to 5, in order of concern for cancer.
A biopsy is not needed to confirm the diagnosis of HCC if certain imaging criteria are met.
Ultrasound, CT scan, and MRI may be used to evaluate the liver for HCC. On CT and MRI, HCC can have three distinct patterns of growth:
A single large tumor
Multiple tumors
Poorly defined tumor with an infiltrative growth pattern
A systematic review of CT diagnosis found that the sensitivity was 68% (95% CI 55–80%) and specificity was 93% (95% CI 89–96%) compared with pathologic examination of an explanted or resected liver as the reference standard. With triple-phase helical CT, the sensitivity was 90% or higher, but these data have not been confirmed with autopsy studies.
However, MRI has the advantage of delivering high-resolution images of the liver without ionizing radiation. HCC appears as a high-intensity pattern on T2-weighted images and a low-intensity pattern on T1-weighted images. The advantage of MRI is that it has improved sensitivity and specificity when compared to ultrasound and CT in cirrhotic patients with whom it can be difficult to differentiate HCC from regenerative nodules. A systematic review found that the sensitivity was 81% (95% CI 70–91%) and specificity was 85% (95% CI 77–93%) compared with pathologic examination of an explanted or resected liver as the reference standard. The sensitivity is further increased if gadolinium contrast-enhanced and diffusion-weighted imaging are combined.
MRI is more sensitive and specific than CT.
Liver image reporting and data system (LI-RADS) is a classification system for the reporting of liver lesions detected on CT and MRI. Radiologists use this standardized system to report on suspicious lesions and to provide an estimated likelihood of malignancy. Categories range from LI-RADS (LR) 1 to 5, in order of concern for cancer. A biopsy is not needed to confirm the diagnosis of HCC if certain imaging criteria are met.
Hepatocellular carcinoma