Imaging of hepatocellular carcinoma recurrence after liver transplantation

• Published in: Insights into imaging 2023-05, Vol.14 (1), p.84-84, Article 84
• Main Authors: Mamone, Giuseppe, Caruso, Settimo, Milazzo, Mariapina, Porrello, Giorgia, Di Piazza, Ambra, Gentile, Giovanni, Carollo, Vincenzo, Crinò, Francesca, Marrone, Gianluca, Sparacia, Gianvincenzo, Maruzzelli, Luigi, Miraglia, Roberto, Gruttadauria, Salvatore
• Format: Article
• Language: English
• Subjects: Computed tomography; Criteria; Diagnostic Radiology; Educational Review; Hepatocellular carcinoma; Imaging; Internal Medicine; Interventional Radiology; Liver; Liver cancer; Liver transplantation; Liver transplants; Magnetic resonance imaging; Medical imaging; Medical prognosis; Medicine; Medicine & Public Health; Neuroradiology; Radiology; Recurrence; Survival; Transplantation; Ultrasound
• ISSN: 1869-4101; 1869-4101
• DOI: 10.1186/s13244-023-01425-6

Liver transplantation (LT) provides the highest survival benefit to patients with unresectable hepatocellular carcinoma (HCC). The Milan criteria have been developed for the selection of LT candidates with the goal of improving survival and maintaining an acceptable risk of HCC recurrence. Despite this, recurrence of HCC after LT occurs in up to 20% of cases and represents a major concern due to the poor prognosis of these patients. Furthermore, several extended criteria for the selection of LT candidates have been proposed to account for the growing demand for organs and the resultant increase in the risk of HCC recurrence. Radiologists should be aware that HCC can recur after LT with multiple organ involvement. Knowledge of the location and radiologic appearance of recurrent HCC is necessary to ensure the choice of the most appropriate therapy. This paper aims to comprehensively summarize the spectrum of HCC recurrence after LT and to examine and discuss the imaging features of these lesions. Graphical Abstract Critical relevance statement This paper aims to share a review of imaging findings of HCC recurrence after LT and to make radiologists familiar with the spectrum of this disease. Key points Recurrence of HCC after LT occurs in up to 20% of cases. HCC recurrence can be intrahepatic, extrahepatic, or both. Recurrent HCC may be in a solitary site or in multiple sites. Recurrent HCC often shows the typical finding of hypervascularity at CT-MR imaging. Knowledge of recurrent HCC imaging findings is necessary to make the correct diagnosis.