{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,24]],"date-time":"2026-09-24T05:01:44Z","timestamp":1790226104604,"version":"4.1.0"},"reference-count":88,"publisher":"MDPI AG","issue":"19","license":[{"start":{"date-parts":[[2026,9,22]],"date-time":"2026-09-22T00:00:00Z","timestamp":1790035200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Diagnostics"],"abstract":"<jats:p>A thoracic finding in a patient with hepatocellular carcinoma (HCC) may represent metastatic disease, vascular extension, treatment-related injury, or a complication of cirrhosis, and each carries different implications for staging and care. The mechanism behind the finding therefore matters as much as the finding itself. We searched the PubMed\/MEDLINE database for articles published up to August 2026 and screened the reference lists of retrieved articles for additional relevant publications. The narrative review is organised into four domains: direct oncological involvement, vascular dissemination, treatment-related injury, and cirrhosis-associated mimics. Within each domain, computed tomography (CT) provides most of the chest assessment, while magnetic resonance imaging, echocardiography, and angiography address more specific anatomical or diagnostic questions. We next discuss common patterns of pulmonary metastasis alongside benign nodules common in transplant candidates, and the biological and small-lesion limitations of functional imaging. Thoracic findings gain meaning in the context of hepatic disease, vascular anatomy, and treatment history. Enhancement and alpha-fetoprotein have never been validated as noninvasive rule-out tests for pulmonary metastasis, so the choice between sampling and surveillance rests on multidisciplinary judgement of the costs of uncertainty, procedural feasibility, and evidence strength.<\/jats:p>","DOI":"10.3390\/diagnostics16193072","type":"journal-article","created":{"date-parts":[[2026,9,22]],"date-time":"2026-09-22T09:04:17Z","timestamp":1790067857000},"page":"3072","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["The Thoracic Footprint of Hepatocellular Carcinoma: A Mechanism-Based Imaging Narrative Review"],"prefix":"10.3390","volume":"16","author":[{"ORCID":"https:\/\/orcid.org\/0009-0007-7057-6573","authenticated-orcid":false,"given":"Carmen Georgiana Pitusac","family":"Prisacaru","sequence":"first","affiliation":[{"name":"\u201cGrigore T. Popa\u201d University of Medicine and Pharmacy, 700115 Iasi, Romania"},{"name":"Department of Radiology and Medical Imaging, Clinical Hospital of Pneumophthisiology, 700115 Iasi, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0004-1793-0746","authenticated-orcid":false,"given":"Ramona","family":"Cadar","sequence":"additional","affiliation":[{"name":"\u201cGrigore T. Popa\u201d University of Medicine and Pharmacy, 700115 Iasi, Romania"},{"name":"Department of Surgery, \u201cSf. Spiridon\u201d Clinical Emergency Hospital, 700116 Iasi, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1522-5766","authenticated-orcid":false,"given":"Cristian Dumitru","family":"Lupascu","sequence":"additional","affiliation":[{"name":"\u201cGrigore T. Popa\u201d University of Medicine and Pharmacy, 700115 Iasi, Romania"},{"name":"Department of Surgery, \u201cSf. Spiridon\u201d Clinical Emergency Hospital, 700116 Iasi, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2054-3841","authenticated-orcid":false,"given":"David","family":"Toma","sequence":"additional","affiliation":[{"name":"\u201cGrigore T. Popa\u201d University of Medicine and Pharmacy, 700115 Iasi, Romania"},{"name":"Pulmonology Clinic, Clinical Hospital of Pneumophthisiology, 700115 Iasi, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0005-9991-4228","authenticated-orcid":false,"given":"Adriana Loredana","family":"Pintilie","sequence":"additional","affiliation":[{"name":"\u201cGrigore T. Popa\u201d University of Medicine and Pharmacy, 700115 Iasi, Romania"},{"name":"Pulmonology Clinic, Clinical Hospital of Pneumophthisiology, 700115 Iasi, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0009-4560-1102","authenticated-orcid":false,"given":"Tudor","family":"Birladeanu","sequence":"additional","affiliation":[{"name":"\u201cGrigore T. Popa\u201d University of Medicine and Pharmacy, 700115 Iasi, Romania"},{"name":"Pulmonology Clinic, Clinical Hospital of Pneumophthisiology, 700115 Iasi, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0003-2868-2736","authenticated-orcid":false,"given":"Ruxandra","family":"Stirbu","sequence":"additional","affiliation":[{"name":"Pulmonology Clinic, Clinical Hospital of Pneumophthisiology, 700115 Iasi, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0009-1947-4373","authenticated-orcid":false,"given":"Raluca Teodora","family":"Tiron","sequence":"additional","affiliation":[{"name":"Pulmonology Clinic, Clinical Hospital of Pneumophthisiology, 700115 Iasi, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Roxana","family":"Cobzariu","sequence":"additional","affiliation":[{"name":"Pulmonology Clinic, Clinical Hospital of Pneumophthisiology, 700115 Iasi, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3732-0350","authenticated-orcid":false,"given":"Radu","family":"Crisan Dabija","sequence":"additional","affiliation":[{"name":"\u201cGrigore T. Popa\u201d University of Medicine and Pharmacy, 700115 Iasi, Romania"},{"name":"Pulmonology Clinic, Clinical Hospital of Pneumophthisiology, 700115 Iasi, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7539-9453","authenticated-orcid":false,"given":"Corina","family":"Lupascu Ursulescu","sequence":"additional","affiliation":[{"name":"\u201cGrigore T. Popa\u201d University of Medicine and Pharmacy, 700115 Iasi, Romania"},{"name":"Department of Radiology and Medical Imaging, \u201cSf. Spiridon\u201d Clinical Emergency Hospital, 700116 Iasi, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2026,9,22]]},"reference":[{"key":"ref_1","first-page":"229","article-title":"Global cancer statistics 2022: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries","volume":"74","author":"Bray","year":"2024","journal-title":"CA Cancer J. 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