Abstract
Purpose
To evaluate the prognosis of “strict” high-risk nodules (small hepatocellular nodules detected only in the hepatobiliary phase of initial Gd-EOB-DTPA-enhanced MR examination) in patients with cirrhosis or chronic hepatitis.
Methods and materials
The study included thirty-three patients with 60 “strict” high-risk nodules showing hypointensity at the hepatobiliary phase that was undetectable at the vascular phase and other conventional sequences of initial Gd-EOB-DTPA-enhanced MR imaging. These nodules were observed on follow-up MR examinations until hypervascularity was detected. The potential predictive factors for hypervascular transformation were compared between two groups (group A showing hypervascular transformation, group B not showing hypervascularization).
Results
Ten (16.7 %) of 60 “strict” high-risk nodules showed hypervascular transformation during follow-up periods (group A). The growth rates of the nodules in group A (6.3 ± 4.5 mm/year) were significantly higher than those in group B (3.4 ± 7.2 mm/year) (p = 0.003). Additionally, the median observation period in group A (177.5 ± 189.5 day) was significantly shorter than in group B (419 ± 372.2 day) (p = 0.045). The other predictive factors were not significantly correlated with hypervascularization.
Conclusions
Subsets of “strict” high-risk nodules showed hypervascular transformation during follow-up periods in association with increased growth rates, indicating that nodule growth rate is an important predictive factor for hypervascularization.
Key Points
• “Strict” high-risk nodules are defined as hepatocellular nodules detected only in the hepatobiliary-phase.
• Subsets of “strict” high-risk nodules showed hypervascular transformation during follow-up periods.
• Increased growth rate is an important predictive factor for hypervascular transformation.
• Management of patients with “strict” high-risk nodules becomes more appropriate.
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References
Ahn SS, Kim MJ, Lim JS, Hong HS, Chung YE, Choi JY (2010) Added value of gadoxetic acid-enhanced hepatobiliary phase MR imaging in the diagnosis of hepatocellular carcinoma. Radiology 255:459–466
Sano K, Ichikawa T, Motosugi U et al (2011) Imaging study of early hepatocellular carcinoma: usefulness of gadoxetic acid-enhanced MR imaging. Radiology 261:834–844
Haradome H, Grazioli L, Tinti R et al (2011) Additional value of gadoxetic acid-DTPA-enhanced hepatobiliary phase MR imaging in the diagnosis of early-stage hepatocellular carcinoma: comparison with dynamic triple-phase multidetector CT imaging. J Magn Reson Imaging 34:69–78
Kitao A, Zen Y, Matsui O et al (2010) Hepatocellular carcinoma: signal intensity at gadoxetic acid-enhanced MR Imaging–correlation with molecular transporters and histopathologic features. Radiology 256:817–826
Ichikawa T (2004) MRI in the evaluation of hepatocellular nodules: role of pulse sequences and contrast agents. Intervirology 47:252–270
Kitao A, Matsui O, Yoneda N et al (2011) The uptake transporter OATP8 expression decreases during multistep hepatocarcinogenesis: correlation with gadoxetic acid enhanced MR imaging. Eur Radiol 21:2056–2066
Higaki A, Ito K, Tamada T et al (2013) High-risk nodules detected in the hepatobiliary phase of Gd-EOB-DTPA-enhanced mr imaging in cirrhosis or chronic hepatitis: incidence and predictive factors for hypervascular transformation, preliminary results. J Magn Reson Imaging 37:1377–1381
Bruix J, Sherman M (2011) Management of hepatocellular carcinoma: an update. Hepatology 53:1020–1022
Kudo M, Izumi N, Kokudo N et al (2011) Management of hepatocellular carcinoma in Japan: consensus-based clinical practice guidelines proposed by the Japan Society of Hepatology (JSH) 2010 updated version. Dig Dis 29:339–364
Motosugi U, Ichikawa T, Sano K et al (2011) Outcome of hypovascular hepatic nodules revealing no gadoxetic acid uptake in patients with chronic liver disease. J Magn Reson Imaging 34:88–94
Kim YK, Lee WJ, Park MJ, Kim SH, Rhim H, Choi D (2012) Hypovascular hypointense nodules on hepatobiliary phase gadoxetic acid-enhanced MR images in patients with cirrhosis: potential of DW imaging in predicting progression to hypervascular HCC. Radiology 265:104–114
Hyodo T, Murakami T, Imai Y et al (2013) Hypovascular nodules in patients with chronic liver disease: risk factors for development of hypervascular hepatocellular carcinoma. Radiology 266:480–490
Neoplasia ICGfH (2009) Pathologic diagnosis of early hepatocellular carcinoma: a report of the international consensus group for hepatocellular neoplasia. Hepatology 49:658–664
Kutami R, Nakashima Y, Nakashima O, Shiota K, Kojiro M (2000) Pathomorphologic study on the mechanism of fatty change in small hepatocellular carcinoma of humans. J Hepatol 33:282–289
Le Moigne F, Durieux M, Bancel B et al (2012) Impact of diffusion-weighted MR imaging on the characterization of small hepatocellular carcinoma in the cirrhotic liver. Magn Reson Imaging 30:656–665
Kumada T, Toyoda H, Tada T et al (2011) Evolution of hypointense hepatocellular nodules observed only in the hepatobiliary phase of gadoxetate disodium-enhanced MRI. AJR Am J Roentgenol 197:58–63
Martin J, Sentis M, Zidan A et al (1995) Fatty metamorphosis of hepatocellular carcinoma: detection with chemical shift gradient-echo MR imaging. Radiology 195:125–130
Matsui M, Kadoya M, Kameyama T et al (1989) Adenomatous hyperplastic nodules in the cirrhotic liver: differentiation from hepatocellular carcinoma with MR imaging. Radiology 173:123–126
Xu PJ, Yan FH, Wang JH, Shan Y, Ji Y, Chen CZ (2010) Contribution of diffusion-weighted magnetic resonance imaging in the characterization of hepatocellular carcinomas and dysplastic nodules in cirrhotic liver. J Comput Assist Tomogr 34:506–512
Acknowledgments
The scientific guarantor of this publication is Katsuyoshi Ito. The authors of this manuscript declare no relationships with any companies whose products or services may be related to the subject matter of the article. The authors state that this work has not received any funding.
No complex statistical methods were necessary for this paper. Institutional Review Board approval was obtained. Written informed consent was waived by the Institutional Review Board. No study subjects or cohorts have been previously reported.
Methodology: Retrospective, diagnostic or prognostic study, performed at one institution.
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Higaki, A., Ito, K., Tamada, T. et al. Prognosis of small hepatocellular nodules detected only at the hepatobiliary phase of Gd-EOB-DTPA-enhanced MR imaging as hypointensity in cirrhosis or chronic hepatitis. Eur Radiol 24, 2476–2481 (2014). https://doi.org/10.1007/s00330-014-3293-8
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DOI: https://doi.org/10.1007/s00330-014-3293-8