Evolution of Hypointense Hepatocellular Nodules Observed Only in the Hepatobiliary Phase of Gadoxetate Disodium–Enhanced MRI

Kumada, Takashi; Toyoda, Hidenori; Tada, Toshifumi; Sone, Yoshitsugu; Fujimori, Masashi; Ogawa, Sadanobu; Ishikawa, T

doi:10.2214/ajr.10.5390

Cited by 143 publications

(157 citation statements)

References 24 publications

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“…This comparative study confirmed the dedifferentiation of HCC with tumor growth (10). Concerning the progression, Kumada et al (11) demonstrated recently that hypointense hepatocellular nodules with maximum diameters ! 15 mm in the hepatobiliary phase of gadolinium-ethoxybenzyl-diethylenetriamine pentaacetic acid enhanced magnetic resonance imaging (Gr-EOB-MRI) become hypervascular (vascularized nodules) at rates of 43.3% and 77.3% during 6 months and 12 months, respectively.…”

Section: Statistical Analysessupporting

confidence: 78%

Severe Inflammation in the Background Liver Cirrhosis Correlates with the Development of Poorly Differentiated HCC in HCV-Associated Liver Cirrhosis

Tarao¹,

Miyakawa

Miyagi

et al. 2012

Intern. Med.

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Objective Whether severe inflammation in the background liver cirrhosis might correlate with the development of poorly differentiated human hepatocellular carcinoma (HCC) was studied in hepatitis C virus (HCV)-associated liver cirrhosis. Methods Out of 214 HCC patients who underwent curative hepatic resection, 148 patients were HCVassociated liver cirrhosis (LC) patients. Out of these 148, 31 patients with small solitary HCC nodule (diameter ! 3 cm) were included in this study. Inflammation in the background LC was evaluated by modified histology activity index (HAI). To evaluate the inflammation, piece meal necrosis, intra lobular cellular degeneration and focal necrosis, portal cellular inflammation (each 0-4) were estimated. In each case, the average HAI was calculated. The grade of malignancy of HCC was determined by World Health Organization (WHO) classification. Results The average HAI score in the cirrhotic portion in 17 patients with poorly differentiated HCC (5.21±1.15, mean ± standard deviation (SD)) was significantly larger than that in 14 patients without poorly differentiated HCC (4.05±0.83, p<0.005). The occurrence rate of HCC containing poorly differentiated HCC component in the patients whose HAI was more than 5.0 was 80.0% (12 out of 15), and was significantly higher compared with those in patients whose HAI was less than 5.0 (5 out of 16, 31.3%, p<0.025). In univariate and multivariate analyses for contribution to poorly differentiated HCC development, HAI was the only significant contributor (p=0.011, p=0.012 respectively). Conclusion It is suggested that severe inflammation in the background cirrhosis accelerates the promotion in the HCC development from HCV-associated LC.

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Section: Statistical Analysessupporting

confidence: 78%

Severe Inflammation in the Background Liver Cirrhosis Correlates with the Development of Poorly Differentiated HCC in HCV-Associated Liver Cirrhosis

Tarao¹,

Miyakawa

Miyagi

et al. 2012

Intern. Med.

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“…In a radio-pathologic correlation study including 111 indeterminate hepatocellular nodules on Gd-EOB-DTPA MRI, Golfieri et al have found 60 benign lesions, 41 premalignant lesions (high-grade dysplastic nodules/early HCC), and 10 HCCs, and concluded that hepatobiliary phase hypointensity is the stronger marker of malignancy [9]. The latter observation is in accordance with a paper by Kumada et al, which have reported that approximately one quarter of Gd-EOB-DTPA hepatobiliary phase hypointense hepatocellular nodules became hypervascular HCCs at follow-up [10]. Moreover, Kim et al have found that hyperintensity on diffusion-weighted (DW) images in hypovascular hepatobiliary phase hypointense nodules increased the risk of progression to hypervascular HCCs [11].…”

Section: Introductionsupporting

confidence: 68%

Evolution of indeterminate hepatocellular nodules at Gd-EOB-DPTA-enhanced MRI in cirrhotic patients

et al. 2018

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Purpose To retrospectively analyze the evolution of indeterminate hepatocellular nodules in cirrhotic patients on serial Gd-EOB-DPTA-enhanced MRI, and to identify predictors of HCC development. Materials and methods This IRB approved study included 33 cirrhotic patients with 69 indeterminate hepatocellular nodules (mean diameter 1.1 cm) at baseline Gd-EOB-DPTA-enhanced MRI and a Gd-EOB-DPTA-enhanced-MRI follow-up of at least 2 years. Two radiologists evaluated size and signal intensity of each nodule at baseline and follow-up. Age, cirrhosis etiology, and HCC history were recorded. Data were compared between nodules that became HCCs at follow-up (HCC) and those that did not (no-HCC). Results On follow-up, 5/69 nodules became HCCs and 64/69 showed indeterminate characteristics. HCC history was more frequently found in HCCs than in no-HCCs. Age, sex, and cirrhosis etiology were not significantly different between HCCs and no-HCCs. HCCs had a significantly greater baseline diameter and increase in size than no-HCCs. Hepatobiliary phase hypointensity was significantly more common in HCCs than in no-HCCs. Multivariate regression analysis showed that increase in size (OR 10.48; sensitivity, 100%; specificity, 81.2%; p < 0.001) and hepatobiliary phase hypointensity (OR 1.02; sensitivity, 100%; specificity, 78.1%; p < 0.001) was associated with HCC development. Conclusion Indeterminate hepatocellular nodules at Gd-EOB-DPTA-enhanced MRI in cirrhotic patients rarely became HCCs. Hepatobiliary phase hypointensity had a weak association with HCC development.

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“…80,81 If left untreated, more than 10z of these lesions will become hypervascular or conventional HCCs within a year. Among early HCCs identiˆed by gadoxetic acid-enhanced MR imaging, an especially important risk factor for hypervascularization is size exceeding 10 mm 87,88 (Fig. 9a-d).…”

Section: Room For Discussionmentioning

confidence: 99%

Rules, Roles, and Room for Discussion in Gadoxetic Acid-enhanced Magnetic Resonance Liver Imaging: Current Knowledge and Future Challenges

Ichikawa

Araki

2013

magn reson med sci

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Since its launch onto the world medical market, gadoxetic acid has received a great deal of attention from a diverse group of researchers, including gastroenterologists, hepatologists, and abdominal radiologists. Gadoxetic acid in liver magnetic resonance (MR) imaging might be considered to have excellent utility. However, several issues remain that radiologists should keep in mind when utilizing this product. We compiled this review to introduce gadoxetic acid, describe how it should be used, highlight the situations in which it is most and least reliable, and suggest potential avenues for future research.

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Evolution of Hypointense Hepatocellular Nodules Observed Only in the Hepatobiliary Phase of Gadoxetate Disodium–Enhanced MRI

Abstract: Hypointense nodules with a maximum diameter of at least 15 mm often become hypervascular. Therefore, patients with hypointense nodules characterized by a maximum diameter of 15 mm or greater should be observed carefully because of the high incidence of vascularization.

Cited by 143 publications

References 24 publications

Severe Inflammation in the Background Liver Cirrhosis Correlates with the Development of Poorly Differentiated HCC in HCV-Associated Liver Cirrhosis

Severe Inflammation in the Background Liver Cirrhosis Correlates with the Development of Poorly Differentiated HCC in HCV-Associated Liver Cirrhosis

Evolution of indeterminate hepatocellular nodules at Gd-EOB-DPTA-enhanced MRI in cirrhotic patients

Rules, Roles, and Room for Discussion in Gadoxetic Acid-enhanced Magnetic Resonance Liver Imaging: Current Knowledge and Future Challenges

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