MRI may be helpful in the diagnosis of hepatocellular carcinoma (HCC). Hepatocyte-specific magnetic resonance contrast agents are used in some parts of the world to improve the accuracy of minimally invasive daignostic techniques.

Common findings of hepatocellular carcinoma on MRI include the following:^{[1][2][3][4][5][6]}

• On T1-weighted MR images, hepatocellular carcinoma is most often hypointense relative to the liver, although hyperintense lesions or areas of hyperintensity within hypointense lesions may be seen.
  • These hyperintense regions within the hepatocellular carcinoma reflect the presence of fat, copper, protein, or blood secondary to intralesional hemorrhage.

• On T2-weighted images, hepatocellular carcinoma is generally hyperintense, although well-differentiated lesions that are isointense relative to the liver parenchyma may be seen.
• Most hepatocellular carcinomas show intense enhancement on arterial phase contrast-enhanced images.
• A large hepatocellular carcinoma (>5 cm) may have a number of characteristic features, such as:
  • Mosaic pattern
  • Tumor capsule
  • Extracapsular extension with formation of satellite nodules
  • Vascular invasion
  • Extrahepatic dissemination, including lymph node and distant metastases
  • The mosaic pattern is created by confluent small nodules separated by thin septa and necrotic areas within the tumor. This pattern is more often depicted on T2-weighted MR images than on T1-weighted images.

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