The diagnosis is achieved using a combination of:
- ultrasound with contrast
- MRI/CT, possibly with contrast (3 phases)
- blood tests (AFP, PIVKA II)
In 9 of 10 cases, radiology (characteristic charging patterns in two modalities) and blood tests are sufficient to make the diagnosis. In 10% of cases of HCC, where there are multiple small lesions and liver cirrhosis, a fine-needle or core biopsy may be necessary.