Figure 1. Algorithm for Investigation of Small Nodules Found on
Screening in Patients at Risk for HCC
HCC
< 1 cm
> 1 cm
Repeat ultrasound
at 3 months
Growing/changing
character
4-phase MDCT/dynamic
contrast enhanced MRI
Arterial hypervascularity
AND venous or delayed
phase washout
Stable
YES
Investigate according
to size
Other contrast enhanced
study (CT or MRI)
HCC
Arterial
hypervascularity
AND venous or
delayed phase
washout
YES
NO
Biopsy
NO
����To best assess the prognosis of HCC patients it is recommended that the
staging system take into account tumor stage, liver function and physical
status. The impact of treatment should also be considered when estimating
life expectancy. Currently, the Barcelona Clinic Liver Cancer (BCLC) system
is the only staging system that accomplishes these aims (II).
