The best hope for cure of HCC is liver transplantation.  There are specific criteria used to determine eligibility for liver transplantation, the most frequent being the Milan criteria:  Patients with a single tumor <5 cm, no more than 3 tumors (all <3 cm), and no extrahepatic spread or macrovascular involvement are eligible for  transplantation.

Hepatic imaging for the detection of hepatocellular carcinoma (HCC) is dominated by dynamic contrast-enhanced CT and MRI.  Lesions >2 cm which display typical imaging characteristics (hyperintensity on T2-weighted MRI images, late arterial enhancement followed by washout on portal venous and delayed phase imaging, often with late rim enhancement) may be accurately characterized as HCC.  Lesions smaller than 2 cm are much more difficult to characterize, and are unfortunately quite common in the cirrhotic liver.   Lesions which demonstrate the above typical characteristics (particularly contrast washout) may be characterized as suspicious for HCC.  Those lesions which are less typical are routinely followed up to evaluate growth, often at 3-6 month intervals, to rule out the presence of HCC. 

Because of the importance placed on the Milan criteria for transplantation, how we as radiologists describe a given lesion becomes critical.  For this reason, the following lexicon for hypervascular hepatic lesions is suggested:

• Hypervascular lesion not characteristic of HCC
• Hypervascular lesion that is indeterminate (follow-up per protocol in 3 months)
  
• Hypervascular lesion suspicious for HCC
• Hypervascular mass characteristic for HCC

Note:  Not all HCC is hypervascular -- some may display an atypical pattern.

For further reading:

• MR Imaging of Hepatocellular Carcinoma in the Cirrhotic Liver: Challenges and Controversies (Willatt - Radiology 2008)
• Diagnostic Imaging of Hepatocellular Carcinoma in Patients With Cirrhosis Before Liver Transplantation (Taouli - Liver Transplantation 2008)