Preventing false positive imaging diagnosis of HCC: differentiating HCC from mimickers and practical strategies

다국어 초록 (Multilingual Abstract)

Noninvasive imaging-based diagnosis of hepatocellular carcinoma (HCC) in high-risk patients plays a central role in clinicalpractice. Current major guidelines typically rely on the radiologic hallmark of nonrim arterial phase hyperenhancement followedby nonperipheral washout, criteria designed to achieve both high positive predictive value and sufficient specificity when appliedwithin well-defined target populations. Despite these criteria, false positive diagnoses still occur and can lead to unnecessary orinappropriate treatment, as various benign and non-HCC malignant lesions may exhibit vascular features that overlap with the classicappearance of HCC. Furthermore, treatment decisions are occasionally guided by imaging findings even in patients outside thetarget population who are being evaluated for possible HCC, in whom vascular patterns are less specific and the risk of false positivediagnosis is inherently higher. Minimizing the risk of false positive diagnosis requires not only adherence to validated imaging criteriabut also clinical and contextual integration when findings are uncertain. This includes consideration of ancillary features, tumormarkers, and, when appropriate, further evaluation through biopsy, additional imaging, or follow-up. This review outlines a range ofHCC mimickers and provides practical strategies to support accurate imaging interpretation and reduce false positive diagnoses inclinical practice.