Hypervascular Transformation of Hypovascular Hypointense Nodules in the Hepatobiliary Phase of Gadoxetic Acid–Enhanced MRI: A Systematic Review and Meta-Analysis

Abstract

Hypovascular hypointense nodules detected in the hepatobiliary phase of gadoxetic acid-enhanced MRI carry a significant potential of transforming into hypervascular HCCs. The size of nodules is a significant risk factor for hypervascular transformation.

Prospective Intraindividual Comparison of Magnetic Resonance Imaging With Gadoxetic Acid and Extracellular Contrast for Diagnosis of Hepatocellular Carcinomas Using the Liver Imaging Reporting and Data System

“…As an inherent strength of HBA‐MRI, one subcentimeter‐sized HCC (9 mm) and two DNs (7 and 16 mm) were depicted only on HBP images but were not clearly seen on other sequences or ECA‐MRI. There is little evidence regarding the clinical impact of early detection and early treatment for such early HCCs and risky nodules progressing to overt hypervascular HCC in terms of patient outcomes . Given that such risky nodules might not be a “target lesion” for treatment but a “signaling lesion” for second overt hypervascular HCC, early recognition of such nodules will usually lead a clinician to follow up with caution .…”

Use of gadoxetate disodium in patients with chronic liver disease and its implications for liver imaging reporting and data system (LI‐RADS)

“…[38][39][40] A recent meta-analysis of such nodules reported a pooled rate of hypervascular transformation of 28% (95% CI, 23-34%) overall, with the pooled 1-, 2-, and 3-year cumulative incidence rates of 18% (95% CI, 9-27%), 25% (95% CI, 12-38%), and 30% (95% CI, 19-42%), respectively. 41 Conversely, only 1-4% of HBP hyperintense nodules without APHE progress to HCC, with a 1-year hypervascularization rate of 0.4-2%. 42,43 In addition to increased risk of progression to HCC, HBP hypointense nodules without APHE are markers of increased HCC development elsewhere in the liver: the cumulative 3-year rate of HCC at sites different from the original HBP hypointense nodules without APHE is reported to be 22%, compared with 6% in patients with no nodules.…”

“…Of newly developed arterially hyperenhancing HCCs, 29–44% were visible as HBP hypointense nodules without APHE on prior imaging . A recent meta‐analysis of such nodules reported a pooled rate of hypervascular transformation of 28% (95% CI, 23–34%) overall, with the pooled 1‐, 2‐, and 3‐year cumulative incidence rates of 18% (95% CI, 9–27%), 25% (95% CI, 12–38%), and 30% (95% CI, 19–42%), respectively . Conversely, only 1–4% of HBP hyperintense nodules without APHE progress to HCC, with a 1‐year hypervascularization rate of 0.4–2% .…”

LI‐RADS 2017: An update

“…34–36 According to Suh et al, 37 a hypointense nodule in the hepatobiliary phase of gadoxetate-enhanced MRI that is nonhypervascular in the arterial phase should be regarded as intermediate risk, whereas one that is hypervascular in the arterial phase should be considered high risk (Fig. 12).…”

“…26,34 Several studies have shown that MRI performed with hepatobiliary contrast agents provides higher sensitivity compared to dynamic contrast-enhanced CT for the detection of HCC, as well as liver metastases. [34][35][36] According to Suh et al, 37 a hypointense nodule in the hepatobiliary phase of gadoxetate-enhanced MRI that is nonhypervascular in the arterial phase should be regarded as intermediate risk, whereas one that is hypervascular in the arterial phase should be considered high risk (Fig. 12).…”