Gadoxetic acid‐enhanced MRI findings of early hepatocellular carcinoma as defined by new histologic criteria

Rhee, Hyungjin; Kim, Do Young; Park, Young Nyun; Choi, Jihun; Kim, Kyungsik

doi:10.1002/jmri.22828

Cited by 44 publications

(39 citation statements)

References 36 publications

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“…Since early HCCs show incomplete neoangiogenesis, isoattenuation on vascular phases is frequently seen in approximately 44% of early HCCs on multiphasic CT images [59]. However, because OATP8 expression decreases during hepatocarcinogenesis prior to complete neoangiogenesis and increased arterial flow, borderline hepatic nodules can be seen as nonhypervascular and hypointense nodules on HBP [80,81,82]. On Gd-EOB-DTPA-enhanced MRI, a considerable number of early HCCs, and some HGDNs, are hypointense on HBP [78] due to underexpression of OATP (Fig.…”

Section: Imaging-based Characterization Of Borderline Hepatic Nodulesmentioning

confidence: 99%

How to Differentiate Borderline Hepatic Nodules in Hepatocarcinogenesis: Emphasis on Imaging Diagnosis

et al. 2017

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Background: Rapid advances in liver imaging have improved the evaluation of hepatocarcinogenesis and early diagnosis and treatment of hepatocellular carcinoma (HCC). In this situation, detection of early-stage HCC in its development is important for the improvement of patient survival and optimal treatment strategies. Because early HCCs are considered precursors of progressed HCC, precise differentiation between a dysplastic nodule (DN), especially a high-grade DN, and early HCC is important. In clinical practice, these nodules are frequently called “borderline hepatic nodules.” Summary: This article discusses radiological and pathological characteristics of these borderline hepatic nodules and offers an understanding of multistep hepatocarcinogenesis by focusing on the descriptions of the imaging changes in the progression of DN and early HCC. Detection and accurate diagnosis of borderline hepatic nodules are still a challenge with contrast enhanced ultrasonography, CT, and MRI with extracellular contrast agents. However, gadoxetic acid-enhanced MRI may be useful for improving the diagnosis of these borderline nodules. Key Messages: Since there is a net effect of incomplete neoangiogenesis and decreased portal venous flow in the early stage of hepatocarcinogenesis, borderline hepatic nodules commonly show iso- or hypovascularity. Therefore, precise differentiation of these nodules remains a challenging issue. In MRI using hepatobiliary contrast agents, signal intensity of HCCs on hepatobiliary phase (HBP) is regarded as a potential imaging biomarker. Borderline hepatic nodules are seen as nonhypervascular and hypointense nodules on the HBP, which is important for predicting tumor behavior and determining appropriate therapeutic strategies.

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Section: Imaging-based Characterization Of Borderline Hepatic Nodulesmentioning

confidence: 99%

How to Differentiate Borderline Hepatic Nodules in Hepatocarcinogenesis: Emphasis on Imaging Diagnosis

et al. 2017

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“…It has actually become common to encounter cases where hypervascular HCC or nodule-in-nodule HCC that is undetectable by MDCT is detected in a routine screening by EOB-MRI because of early enhancement in the arterial phase or clear hypointensity in the hepatobiliary phase [11,18,19,20,21,22,23,24,25,26,27,28,29,30,31,32,33,34,35,36,37,38,39,40,41,42,43,44,45,46,47,48,49,50,51,52,53,54,55,56,57,58,59,60,61,62,63,64,65,66,67,68,69,70,71,72,73,74,75,76,77,78,79,80,81,82,83,84,85,86,87,88,89,90,91,92,93,94,95,96,97,98,99,100,101,102,103]. Furthermore, studies comparing the diagnostic performance of EOB-MRI and MDCT for hypervascular HCC have shown that EOB-MRI is superior or, at the very l...…”

Section: Diagnostic Algorithmmentioning

confidence: 99%

Surveillance and Diagnostic Algorithm for Hepatocellular Carcinoma Proposed by the Liver Cancer Study Group of Japan: 2014 Update

et al. 2014

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Surveillance and diagnostic algorithms for hepatocellular carcinoma (HCC) have already been described in guidelines published by the American Association for the Study of Liver Diseases (AASLD), the European Association for the Study of the Liver and the European Organisation for Research and Treatment of Cancer (EASL-EORTC), and the Japan Society of Hepatology (JSH), but the content of these algorithms differs slightly. The JSH algorithm mainly differs from the other two algorithms in that it is highly sophisticated and considers the functional imaging techniques of gadolinium ethoxybenzyl diethylenetriamine pentaacetic acid-enhanced MRI (EOB-MRI) and Sonazoid contrast-enhanced ultrasound (CEUS) to be very important diagnostic modalities. In contrast, the AASLD and EASL-EORTC algorithms are less advanced and suggest that a diagnosis be made based solely on hemodynamic findings using dynamic CT/MRI and biopsy findings. A consensus meeting regarding the JSH surveillance and diagnostic algorithm was held at the 50th Liver Cancer Study Group of Japan Congress, and a 2014 update of the algorithm was completed. The new algorithm reaffirms the very important role of EOB-MRI and Sonazoid CEUS in the surveillance and diagnosis of liver cancer and is more sophisticated than those currently used in the United States and Europe. This is now an optimized algorithm that can be used to diagnose early-stage to classical HCC easily and highly accurately.

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“…Thus, in addition to the enhancement pattern, more information is needed to diagnose indeterminate nodules. Hepatocyte-specific contrast agents (so-called dual functional agents) may provide additional functional information that can improve the detection and characterization of HCCs [103][104][105][106][107][108][109][110].…”

Section: Mri Using New Contrast Mediamentioning

confidence: 99%

New Paradigm for Management of Hepatocellular Carcinoma by Imaging

Joo

Choi

2012

Liver Cancer

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Based on recent clinical practice guidelines, imaging is largely replacing pathology as the preferred diagnostic method for determination of hepatocellular carcinoma (HCC). A variety of imaging modalities, including ultrasound (US), computed tomography (CT), magnetic resonance imaging (MRI), nuclear medicine, and angiography, are currently used to examine patients with chronic liver disease and suspected HCC. Advancements in imaging techniques such as perfusion imaging, diffusion imaging, and elastography along with the development of new contrast media will further improve the ability to detect and characterize HCC. Early diagnosis of HCC is essential for prompt treatment, which may in turn improve prognosis. Considering the process of hepatocarcinogenesis, it is important to evaluate sequential changes via imaging which would help to differentiate HCC from premalignant or benign lesions. Recent innovations including multiphasic examinations, high-resolution imaging, and the increased functional capabilities available with contrast-enhanced US, multidetector row CT, and MRI have raised the standards for HCC diagnosis. Although hemodynamic features of nodules in the cirrhotic liver remain the main diagnostic criterion, newly developed cell-specific contrast agents have shown great possibilities for improved HCC diagnosis and may overcome the diagnostic dilemma associated with small or borderline hepatocellular lesions. In the 20th century paradigm of medical imaging, radiological diagnosis was based on morphological characteristics, but in the 21st century, a paradigm shift to include biomedical, physiological, functional, and genetic imaging is needed. A multidisciplinary team approach is necessary to foster an integrated approach to HCC imaging. By developing and combining new imaging modalities, all phases of HCC patient care, including screening, diagnosis, treatment, and therapy, can be dramatically improved.

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Gadoxetic acid‐enhanced MRI findings of early hepatocellular carcinoma as defined by new histologic criteria

Cited by 44 publications

References 36 publications

How to Differentiate Borderline Hepatic Nodules in Hepatocarcinogenesis: Emphasis on Imaging Diagnosis

How to Differentiate Borderline Hepatic Nodules in Hepatocarcinogenesis: Emphasis on Imaging Diagnosis

Surveillance and Diagnostic Algorithm for Hepatocellular Carcinoma Proposed by the Liver Cancer Study Group of Japan: 2014 Update

New Paradigm for Management of Hepatocellular Carcinoma by Imaging

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