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Background Hepatocellular carcinoma (HCC) appears in most of cases in patients with advanced liver disease and is currently the primary cause of death in this population. Surveillance of HCC has been proposed and recommended in clinical guidelines to obtain earlier diagnosis, but it is still controversial and is not accepted worldwide. Aim To review the actual evidence to support the surveillance programs in patients with cirrhosis as well as the diagnosis procedure. Methods Systematic review of recent literature of surveillance (tools, interval, cost-benefit, target population) and the role of imaging diagnosis (radiological non-invasive diagnosis, optimal modality and agents) of HCC. Results The benefits of surveillance of HCC, mainly with ultrasonography, have been assessed in several prospective and retrospective analysis, although the percentage of patients diagnosed in surveillance programs is still low. Surveillance of HCC permits diagnosis in early stages allows better access to curative treatment and increases life expectancy in patients with cirrhosis. HCC is a tumor with special radiological characteristics in computed tomography and magnetic resonance imaging, which allows highly accurate diagnosis without routine biopsy confirmation. The actual recommendation is to perform biopsy only in indeterminate nodules. Conclusion The evidence supports the recommendation of performing surveillance of HCC in patients with cirrhosis susceptible of treatment, using ultrasonography every 6 mo. The diagnosis evaluation of HCC can be established based on noninvasive imaging criteria in patients with cirrhosis.

Purpose To evaluate if respiratory coaching performed prior to CT pulmonary angiography (CTPA) image acquisition has an impact on the occurrence of transient interruption of contrast (TIC) phenomenon. Materials and methods Two hundred and thirty-one consecutive patients with suspected pulmonary embolism (PE) were referred for CTPA. They were randomised into two groups, with or without respiratory coaching (groups A and B, respectively). Those patients who were deemed not able to be coached were not randomised and were assigned to a third group (C). Two radiologists evaluated the degree of enhancement of the pulmonary arteries and the presence and grade of TIC. The χ2 test was used to compare differences among groups in occurrence and grade of this phenomenon. Results There were no significant differences in the presence of any grade of TIC among the three groups, with 30 positive cases (32%) in group A, 33 (35%) in group B, and 12 (27%) in group C (P = 0.61). When TIC was graded and divided into significant or not, the different groups also did not differ significantly. Conclusion Performing respiratory coaching before CTPA had no statistically significant effect on the incidence and severity of TIC in this prospective randomised study. Main Messages • Significant transient interruption of contrast appears in 12% of pulmonary CT angiograms. • Severe transient interruption of contrast leading to nondiagnostic tests appears in 2% of studies. • In our study respiratory coaching has no impact on the incidence of transient interruption of contrast.