Objectives

To reinforce the importance of nonalcoholic fatty liver disease (NAFLD) as an etiology of hepatocellular carcinoma (HCC).

To discuss the main imaging features to differentiate benign lesions, such as hepatocellular adenoma, from HCC in patients with nonalcoholic steatohepatitis (NASH).

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Background

HCC is the fifth most prevalent cancer worldwide and its leading cause is chronic hepatitis C virus infection. Notwithstanding, there is established evidence of NAFLD progression to HCC, particularly among patients who developed NASH with fibrosis or cirrhosis. However, HCC can also develop in patients with noncirrhotic NASH.

Imaging findings OR Procedure findings

We selected NAFLD patients with focal liver lesions who underwent MRI and will demonstrate key imaging findings to detect diffuse liver disease, different stages of liver fibrosis and characteristics to diagnose early HCC. These cases were confirmed by pathology.

Conclusion

The possibility of NASH should be considered in patients with NAFLD that presents with a hepatic nodule. The investigation with additional methods, such as elastography and laboratory tests, should be performed. In NASH there is hepatocyte injury and potential hepatocarcinogenesis of the nodule. To discern these nodules from benign lesions, such as hepatocellular adenoma, we have used the major imaging features of LI-RADS, even without cirrhosis, such as growth, arterial hyperenhancement, washout and capsule enhancement, as well as ancillary features, such as intracellular fat, diffusion restriction and slight high signal at T2.