Figure 1. Algorithm for Investigation of Small Nodules Found on Screening in Patients at Risk for HCC
HCC < 1 cm
Repeat ultrasound at 3 months
Growing/changing character
Stable > 1 cm
4-phase MDCT/dynamic contrast enhanced MRI
Arterial hypervascularity AND venous or delayed phase washout
YES
Other contrast enhanced study (CT or MRI)
Investigate according to size
HCC
hypervascularity AND venous or delayed phase washout
Arterial YES NO
NO
Biopsy
ÎTo 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).
