Table 2. Comparison of KLCA-NCC, APASL, AASLD, LI-RADS, and EASL Guidelines.
| KLCA-NCC 2018 | APASL 2017 | AASLD 2018 | LI-RADS 2018 | EASL 2018 | |
|---|---|---|---|---|---|
| Target population | CHB, CHC, LC of any cause | All patients at high risk for HCC | LC of any cause | CHB, LC of any cause, patients with current or prior HCC | LC of any cause |
| Target lesion | Detected nodule at surveillance test (CT/MR detected nodule in select patients*) | US detected nodule | US detected nodule (CT/MR detected nodule in select patients*) | All nodules | Mass/nodule at imaging |
| Primary imaging modality | CT, MRI using ECCM or HBCM | CT, MRI using ECCM or HBCM | CT, MRI using ECCM or HBCM | CT, MRI using ECCM or HBCM, CEUS† | CT, MRI using ECCM or HBCM |
| Secondary imaging modality | Yes - CEUS† | Yes - CEUS (Sonazoid‡) | No | No | Yes - CEUS† |
| Diagnostic hallmark | Nodule size > 1 cm | 1) Dynamic CT/MR | Nodule size > 1 cm | Nodule size > 1 cm | Nodule size > 1 cm |
| APHE | APHE | APHE | 1) Dynamic CT, MRI using ECCM or HBCM | APHE | |
| Washout on PVP/DP | Washout on PVP/DP | Washout on PVP/DP | APHE | Washout on PVP/DP | |
| Washout on PVP/TP or hypointensity on HBP, when HBCM is used | 2) HBCM MRI | Washout on PVP, when HBCM is used | Washout on PVP/DP | Washout on PVP, when HBCM is used | |
| (a) APHE, washout on PVP | Washout on PVP, when HBCM is used enhancing capsule | ||||
| (b) APHE, no washout on PVP + hypointensity on HBP | Threshold growth | ||||
| (c) No APHE + hypointensity on HBP + APHE & Kupffer phase defects on CEUS (Sonazoid‡) | 2) CEUS | ||||
| APHE | |||||
| Late (> 60 s) and mild washout | |||||
| Ancillary findings | Yes | No | Yes | Yes | No |
| - Intermediate high SI on T2WI, high SI on DWI, and interval growth on follow-up imaging | - Up scoring (up to LR-4) | - Up scoring (up to LR-4) | |||
| - Presence of capsule, mosaic appearance, nodule-in-nodule appearance, intratumoral fat or hemorrhage | - Down scoring | - Down scoring | |||
| Exclusion criteria | Yes | No | No | No | No |
| When HBCM is used | |||||
| - T2 bright SI | |||||
| - Targetoid appearance in DWI or CE-T1WI | |||||
| Number of required examinations | 1 | 1 | 1 | 1 | 1 |
| Tumor marker (AFP) | N/A | N/A | N/A | N/A | N/A |
| Category | HCC | HCC | Benign (LR-1) | Benign (LR-1) | HCC |
| Probable HCC | Non-HCC | Probably benign (LR-2) | Probably benign (LR-2) | Non-HCC | |
| Indeterminate | Indeterminate (LR-3) | Indeterminate (LR-3) | |||
| Probably HCC (LR-4) | Probably HCC (LR-4) | ||||
| Definitely HCC (LR-5) | Definitely HCC (LR-5) | ||||
| Malignancy, not definitely HCC (LR-M) | Tumor in vein (LR-TIV) | ||||
| Malignancy, not definitely HCC (LR-M) | |||||
| Noninvasive diagnosis of subcentimeter HCC | No | Yes | No | No | No |
| Nonivasive diagnosis of hypovascular HCC | No | Yes | No | No | No |
*Some high-risk patients may undergo multiphase CT or MRI for HCC surveillance (depending on patient body habitus, visibility of liver at ultrasound, being on transplant waiting list and other factors), †Pure blood-pool contrast agents, ‡Sonazoid; GE Healthcare. AASLD = Association for Study of Liver Diseases, AFP = alpha-fetoprotein, APASL = Asian-Pacific Association for Study of Liver, DP = delayed phase, DWI = diffusion-weighted imaging, EASL = European Association for Study of Liver, ECCM = extracellular contrast media, HBCM = hepatobiliary contrast media, LC = liver cirrhosis, LI-RADS = Liver Imaging Reporting and Data System, MR = magnetic resonance, N/A = not applicable, PVP = portal venous phase, SI = signal intensity, TIV = tumor in vein, TP = transitional phase, T1WI = T1-weighted image, T2WI = T2-weighted image