Professor of Radiology, University of Paris Diderot Sorbonne Cité Chair, Department of Radiology The University Beaujon Hospital Clichy, France



Hepatocellular carcinoma (HCC) is the most common type of liver cancer, accounting for 80–90% of all cases of liver cancer. It is the fifth most common cancer and the third leading cause of cancer-related deaths around the world. As HCC occurs in 90%   of the cases in patients with chronic liver disease, screening is indicated in those patients having compensated cirrhosis.
Several guidelines have been implemented to help the practionner to manage the patients during the screening, when a nodule is detected and to decide the optimal treatment in patients  with  HCC. Among the HCC guidelines which are the most used: AASLD, EASL, Japanese, Korean, and Asia-Pacific ones, there are common features. All agree: i) on  the noninvasive diagnosis of HCC using contrast- enhanced CT or MR imaging with two hallmarks: hypervascularization on arterial-phase and wash-out on portal and/or delayed phase in lesions larger than one centimeter; ii) on the role of liver biopsy when diagnosis cannot be achieved with imaging.
Yet they differ in many other issues: stratification
according to lesion size, first-line imaging modality, role of hepatobiliary MR contrast agents, role of contrast-enhanced ultrasound. These  differences  are explained by the different prevalence of HCC worldwide and the different goals of diagnostic performance (high specificity or high sensitivity). This lecture will focus on the recent European guidelines, which propose a n algorithm in patients with chronic liver diseases.