Actually, the main important clue suggesting the diagnosis of HCC within cirrhosis is the identification of a typical vascular supply of the nodule, characterized by contrast-agent washin during the arterial phase and washout on the portal venous or late phase. However, a typical vascular behavior at dynamic imaging modalities is not present in the 30% of HCC [5]. In these cases, baseline and postcontrast MRI, especially after administration of hepatospecific contrast media, may lead to a definitive diagnosis of HCC. On baseline T1-WI, HCC usually appears as a hypointense nodule because of its increased cellularity, and thus its higher amount of intracellular water, whereas on baseline T2-WI, HCC usually shows mild signal hyperintensity [2]. Well differentiated HCC might not show these signal intensities on baseline sequences, resulting examination, resulting isointense on T2-WI. Although their application has not yet been introduced into diagnostic guidelines, the use of tissuespecific contrast agents may give additional information, especially in the presence of borderline lesions (DNs) or well-differentiated HCCs. Regarding hepatobiliary contrast agents, the lack of contrast uptake is strongly related to overt HCC due to the loss of normal metabolic function, whereas uptake is preserved in early HCCs, resembling that of HGDN [6]. In daily practice, the advantages of the most recent generation of MRI contrast media can be exploited, as they illustrate the nodule’s characteristic vascular and hepatospecific phases, i.e., neoangiogenesis and lack of hepatobiliary function, respectively, which allow a highly confident diagnosis of malignancy (Fig. 2).

Nowadays, the advantages of imaging-guided treatments have enlarged the therapeutic approaches of cirrhotic patients with HCC, permitting a tailored therapeutic strategy on the basis clinical and functional data and on patient staging [7]. Despite transplantation represents the best therapeutic approach for a cirrhotic patient, miniinvasive treatments, such as percutaneous ablation with radiofrequency or microwave, are actually considered a good alternative to resection. Intravascular procedures, such as chemoembolization, should instead be applied in intermediate patients with good performance status, as a palliative treatment, and in patients on waiting list for transplantation, in order to down stage those exceeding Milan’s criteria [8]. Radioembolization is the newly introduced intravascular approach, reserved for patients with good performance status with large, locally advanced HCC, also involving a portal branch; this therapy permits downstaging patients otherwise classified as intermediate, who can then benefit from subsequent therapeutic approaches [9].

Peripheral intrahepatic cholangiocellular carcinoma (IHCCC) arises from cholangiocytes of the second order of intrahepatic biliary ducts and represents 10% of all CCC; it generally occurs in the elderly (70s and 80s) and more frequently affects men than women [10]. The vast majority (95%) of these tumors are represented by adenocarcinomas. Well known risk factors for developing such neoplasm are primary sclerosing cholangitis or other chronic conditions, such as hepatolithiasis, bile stenosis, congenital hepatic fibrosis, and recurrence of biliary inflammations [11]. In recent years, moreover, the evidence of a number of concomitant chronic hepatitis C virus (HCV) infections associated with IHCCC suggests that the virus might play a role in the development of biliary neoplasm due to the common precursor (oval cell) of hepatocytes and cholangiocytes [12].

According to the Liver Cancer Study Group of Japan consensus [13], IHCCC are classified on the basis of macroscopic appearance and growth characteristics into three distinct forms: (1) mass-forming type; (2) periductal infiltrating type; (3) intraductal growing type. Different prognoses are related to different types: if the mass-forming and periductal infiltrating types usually have a poor prognosis, intraductal growing types might successfully benefit from surgery. As for the majority of pathological conditions, in cases of IHCCC, imaging modalities play a key role in lesion detection and characterization.