Korean J Radiol.  2019 Jul;20(7):1019-1041. 10.3348/kjr.2018.0636.

Atypical Appearance of Hepatocellular Carcinoma and Its Mimickers: How to Solve Challenging Cases Using Gadoxetic Acid-Enhanced Liver Magnetic Resonance Imaging

  • 1Department of Radiology, Seoul National University Hospital, Seoul, Korea. jmsh@snu.ac.kr
  • 2Department of Radiology, Seoul National University College of Medicine, Seoul, Korea.
  • 3Institute of Radiation Medicine, Seoul National University Medical Research Center, Seoul, Korea.


Hepatocellular carcinoma (HCC) can be diagnosed noninvasively with contrast-enhanced dynamic computed tomography, magnetic resonance imaging, or ultrasonography on the basis of its hallmark imaging features of arterial phase hyperenhancement and washout on portal or delayed phase images. However, approximately 40% of HCCs show atypical imaging features, posing a significant diagnostic challenge for radiologists. Another challenge for radiologists in clinical practice is the presentation of many HCC mimickers such as intrahepatic cholangiocarcinoma, combined HCC-cholangiocarcinoma, arterioportal shunt, and hemangioma in the cirrhotic liver. The differentiation of HCCs from these mimickers on preoperative imaging studies is of critical importance. Hence, we will review the typical and atypical imaging features of HCCs and the imaging features of its common mimickers. In addition, we will discuss how to solve these challenges in practice.


Atypical hepatocellular carcinoma; Hepatocellular carcinoma mimickers; Intrahepatic mass-forming cholangiocarcinoma; Combined hepatocellular-cholangiocarcinoma; Liver Imaging Reporting and Data System

MeSH Terms

Carcinoma, Hepatocellular*
Magnetic Resonance Imaging*
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