How to differentiate cirrhosis nodules from liver cancer nodules

In general, liver cancer is often accompanied by liver cirrhosis. In clinical practice, the problem of distinguishing liver cirrhosis nodules from liver cancer nodules is often encountered. If it is a large liver cancer, the alpha-fetoprotein is positive, and there are typical features on ultrasound, CT or MRI, so the distinction is not particularly difficult. However, some small liver cancers are somewhat similar to liver cirrhosis nodules in imaging, so careful differentiation is required.

Of course, the first thing to do is to check the blood alpha-fetoprotein. The alpha-fetoprotein level in cirrhotic nodules is not elevated, while that in most liver cancer nodules is elevated. Imaging examinations are very valuable in distinguishing cirrhotic nodules from liver cancer nodules. Ordinary ultrasound is generally difficult to distinguish. The following three methods can be used:

After the injection of ultrasound contrast agent, liver cancer nodules have early arterial enhancement, and in the venous phase, they become lower echo than the surrounding liver parenchyma. However, after the injection of contrast agent, cirrhosis nodules do not have the same early enhancement as liver cancer nodules, but instead enhance and weaken synchronously with the surrounding liver parenchyma.

2. Enhanced CT

The manifestations of enhanced CT are similar to those of ultrasound angiography. Liver cancer nodules have early enhancement, while sclerotic nodules do not have early enhancement.

3. Nuclear Magnetic Resonance

MRI is more valuable in differentiating cirrhotic nodules from liver cancer nodules. First, there is a significant difference in the signals of the two. For example, liver cancer nodules show low signals on T1WI (a term for MRI examinations, the same below) weighted images of MRI, and slightly high signals on T2WI weighted images; while sclerotic nodules are the opposite, showing high signals on T1WI weighted images and slightly low signals on T2WI weighted images. Furthermore, MRI can also perform enhanced scanning, which can also distinguish sclerotic nodules from liver cancer nodules.

Of course, if imaging differentiation is difficult, a fine needle liver puncture biopsy can be performed if necessary, and pathological examination can confirm whether it is a small hepatocellular carcinoma or a sclerotic nodule.