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Imaging is used to screen, detect, characterized, grade, stage and follow-up hepatocellular carcinoma lesions and to evaluate the severity of the underlying liver disease. In this chapter, we will summarize the different worldwide diagnostic guidelines assisting decisions to be taken in the process of hepatocarcinogenesis with a deep insight into similarities and differences. The differences in modalities, protocols, dynamic and intracellular contrast-enhanced approaches, main and secondary criteria, vocabulary, ontology, terminology and pitfalls will be discus and highlighted. The structured standardized radiology reporting and radiomics quantitative information will be also highlighted.

Purpose : Groupe Européen de Curiethérapie (GEC) and European Society for Radiotherapy & Oncology (ESTRO) has proposed a rectal dose constraint of the most exposed 2-cc volume (D 2cc of ≤ 75 Gy EQD 2α/β = 3) during external- beam plus high-dose-rate brachytherapy (HDR-BT) in localized prostate cancer patients. This study aimed to evaluate D 2cc for rectal contouring via interobserver variability. Material and methods: Four blinded observers contoured rectums of 5 patients. Rectal contouring anatomical limits were determined through previous consensus. Dose-volume histogram (DVH) dosimetric parameters (D 0.1cc , D 1cc , and D 2cc ) were analyzed according to GEC/ESTRO recommendations and subjected to intra- and interobserver comparisons. Latter comparisons involved coefficients of variation. For each parameter, the mean, standard deviation (SD), and range were evaluated. The effect of interobserver variation on total dose was analyzed by estimating the biologically equivalent rectal dose (EQD 2α/β = 3). Results : Interobserver coefficients of variation for D 0.1cc , D 1cc , and D 2cc were 5.7%, 4.5%, and 4%, respectively. The high­est interobserver rectal delineation variation yielded a rectal dose difference up to 5.8 Gy EQD2. Estimated intraobserver variation for the reported D 2cc was 5.5% in the worst-case scenario (non-significant). Conclusions : We observed acceptable interobserver variability in EQD2 for D 2cc , with strong impacts on clinical threshold levels (D 2cc ≤ 75 Gy EQD2) in some cases. This small, single-center analysis will be extended in a multicenter study.

® was ad- ministered by rapid intravenous infusion (≈ 1 ml/s), and the GE se- quence was repeated and completed by an STIR sequence. Correla- tions between presence of cirrhosis and enhancement pattern of hepatic parenchyma, number of lesions detected before and after bolus administration, as well as lesion histology and degree of enhancement were all analyzed. Adverse clinical reactions as reported by patients were also noted. Results: Cirrhotic liver was found in 49% of the patients. Enhan- cement was mainly heterogeneous with hypointense areas and hete- rogeneous with hypointense areas together with more greatly enhan- ced regenerative nodules. Enhancement of cirrhotic livers was homo- geneous in a third of the cases. Non-cirrhotic patients exhibited a homogeneous hepatic mass in most cases, with only one liver sho- wing heterogeneous enhancement containing hypointense bands cau- sed by necrotic debris having resulted from treated metastases. En- hancement pattern differences between cirrhotic and non-cirrhotic patients were statistically significant (p = 0.001). In 20 of the 31 pa- tients, solid focal lesions were detected. Sequences performed after bolus administration of contrast media detected more lesions than did those before administration. Combination of both post-administration sequences (T1 and STIR) detected the most lesions, with differences between it and pre-administration sequences being statistically signi- ficant (p = 0.014). There was observed a varying degree of lesion en- hancement. Such variability was associated with the nature of the le- sion, with those containing hepatocytes being enhanced. Most pa- tients exhibited a sensation of hot flashes (28 of 31, 90%) and no discomfort in the area of injection. No other adverse reactions were reported.

Background. New direct antiviral agents (DAA) for hepatitis C virus treatment result in sustained virologic response (SVR) in most patients. However, predicting the point of no return is still an unmet need for those with advanced liver disease. The aim is to assess if baseline liver volume is a predictor of post-SVR liver function. Methods. Cirrhotic patients assessed for liver transplantation and consecutively treated with DAA between September 2014 and 2015 who achieved an SVR were included. Pretreatment liver volume (LV) and spleen volume (SV) adjusted by body surface area (BSA) were calculated from computed tomography/magnetic resonance images. Liver function was assessed by Child-Turcotte-Pugh (CTP) and Model for End-Stage Liver Disease (MELD) scores, and a multivariable mixed regression model was used to identify baseline factors associated with improvement of liver function overtime. Results. We included 42 patients with a median age of 58.6 years (first quartile to third quartile, 52.7-68.8); MELD, 14 (11-17); CTP, 9 (8-10); LV, 1400.9 mL (1183.2-1601.4); SV, 782.9 mL (490.6-1118.8). MELD scores at baseline and at last control were 14 (11-17) and 10 (8-12), respectively (P < 0.001); CTP scores were 9 (8-10) and 6 (5-7), respectively (P < 0.001). In the multivariable model, higher LV/BSA was associated with an improvement of MELD and CTP over time (P=0.03 and P=0.044, respectively). Conclusions. LV is a noninvasive tool that can predict functional improvement in cirrhotic patients undergoing DAA therapies.