Mandatory medical device diagnostics.
- Abdominal ultrasonography* (ultrasonography of abdominal organs) – for basic diagnosis of suspected liver disease [echogenic to low-echo; about two-thirds of hepatocellular carcinomas are < 2 cm and low-echo, regardless of histologic differentiation; pay particular attention to signs of malignancy such as:
- Vascular infiltration or compression (exertion of pressure on a tissue) of the portal vein and inferior vena cava (inferior vena cava)
- Tumor thrombosis
- Regional lymph node involvement]
Furthermore, vascular abnormalities (multiple afferent vessels with a basket-like aspect; irregular intratumoral vascularization pattern) are readily demonstrated by color Doppler ultrasonography in hepatocellular carcinoma.Note: CEUS (contrast-enhanced ultrasonography), which uses gas-filled microbubbles as a contrast agent, is considered equivalent for noninvasive diagnosis of hepatocellular carcinoma.
- Contrast-enhanced dynamic computed tomography (CT) of the abdomen (abdominal CT) or magnetic resonance imaging of the abdomen (abdominal MRI), here early arterial contrast enhancement as well as a “washout” in the venous phase – these methods allow the detection of foci > 1 cm in liver cirrhosis (liver shrinkage) and are considered equivalent for the noninvasive diagnosis of hepatocellular carcinoma.
- Intraoperative sonography with ultrasound contrast agent – to detect smaller foci of carcinoma.
* Specialty societies recommend AFP determination and sonography (ultrasonography) every six months in patients with liver cirrhosis as screening for hepatocellular carcinoma.
