Presence of a hypovascular hepatic nodule showing hypointensity on hepatocyte‐phase image is a risk factor for hypervascular hepatocellular carcinoma

Ichikawa, Shintaro; Ichikawa, Tomoaki; Sano, Katsuhiro; Morisaka, Hiroyuki; Enomoto, Nobuyuki; Matsuda, Masanori; Fujii, Hideki; Araki, Tsutomu

doi:10.1002/jmri.24164

Cited by 30 publications

(23 citation statements)

References 26 publications

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“…In contrast to other types of early cancer (4,5), multicentric hepatocarcinogenesis in the remnant liver could not be avoided after surgery in patients with early HCC, and half of the patients who underwent liver resection for early HCC had recurrence within 4 years. Consistent with our data, previous studies have reported that the presence of hypovascular nodules at resection for hypervascular HCC is a risk factor for postoperative recurrence, which may be mainly ascribed to multicentric hepatocarcinogenesis (11,22). Furthermore,~40% of second primary HCCs arising after resection of early HCCs could not be treated curatively, and the development of a second primary HCC was an important prognostic factor, which supports our contention that treatment of early HCC did not beneficially alter the prognosis of patients and is not necessarily required immediately (8).…”

Section: Discussionsupporting

confidence: 81%

Early hepatocellular carcinoma as a signaling lesion for subsequent malignancy

Midorikawa¹,

Takayama²,

Higaki³

et al. 2016

Japanese Journal of Clinical Oncology

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Objective: Early diagnosis and treatment of cancer may contribute substantially to complete cure, but it remains unknown whether treatment of early hepatocellular carcinoma can actually result in cure. This study was performed to clarify the cancer risk of the background liver after treating early hepatocellular carcinoma. Methods: Early hepatocellular carcinoma is defined as very well-differentiated cancer containing Glisson's triad. The cumulative incidence of classical hepatocellular carcinoma, hypervascular liver cancer detected on imaging studies, after resection of early hepatocellular carcinoma positive for anti-hepatitis C antibody (early hepatocellular carcinoma group, n = 105) was compared with that in patients with chronic liver disease positive for anti-hepatitis C antibody (control group, n = 751) and propensity score-matched patients after resection of classical hepatocellular carcinoma (classical hepatocellular carcinoma group, n = 105). Results: After a median follow-up of 4.8 years (range, 0.3-15.0), the cumulative incidence of classical hepatocellular carcinoma at 5 years was 56.9% (95% confidence interval, 44.2-67.7%) in the early hepatocellular carcinoma group and 70.6% (52.5-81.8%) in the classical hepatocellular carcinoma group as compared with 4.6% (2.8-6.4%) in the control group. The risk of the development of classical hepatocellular carcinoma in the early hepatocellular carcinoma group was significantly higher than that in the control group (hazard ratio, 17.5; 95% confidence interval, 12.1-25.3; P < 0.001) and significantly lower than that in the classical hepatocellular carcinoma group (hazard ratio, 0.60; 0.41-0.89; P = 0.010). However, the cumulative incidence of second primary hepatocellular carcinoma in patients with one early hepatocellular carcinoma did not differ significantly from that in patients with two or more early hepatocellular carcinoma lesions (hazard ratio, 1.50; 0.85-2.65; P = 0.157). Conclusions: Treatment of early hepatocellular carcinoma cannot provide complete cure due to the substantial risk of developing classical hepatocellular carcinoma.

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Section: Discussionsupporting

confidence: 81%

Early hepatocellular carcinoma as a signaling lesion for subsequent malignancy

Midorikawa¹,

Takayama²,

Higaki³

et al. 2016

Japanese Journal of Clinical Oncology

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“…In addition, our results are also similar to the results of a previous study by Yamamoto et al [52], which reported that approximately one third of newly developed hypervascular HCCs showed presence of a high-risk nodule before hypervascularization on serial gadoxetic acid-enhanced MRI. Therefore, based on our study results as well as other previous study results [49,50,51,53], we believe that as a significant percentage of non-hypervascular HBP hypointense cirrhotic nodules turn out to be pathologically HCC and will likely develop malignant imaging features on serial radiologic evaluation, these non-hypervascular HBP hypointense cirrhotic nodules need to be considered as being suspicious for malignancy or having malignant potential even though they are hypovascular.…”

Section: Discussionmentioning

confidence: 92%

Non-Hypervascular Hypointense Nodules ≥1 cm on the Hepatobiliary Phase of Gadoxetic Acid-Enhanced Magnetic Resonance Imaging in Cirrhotic Livers

Yoon

Lee

Yang

et al. 2014

Dig Dis

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Objective: To determine the pathologic nature of non-hypervascular hypointense nodules (≥1 cm) on the hepatobiliary phase (HBP) of gadoxetic acid-enhanced magnetic resonance (MR) imaging and to describe the chronological changes of their imaging features on follow-up MR imaging. Patients and Methods: This retrospective study was approved by our Institutional Review Board and the requirement for informed consent was waived. 69 patients with 115 non-hypervascular HBP hypointense nodules (≥1 cm in diameter) in cirrhotic livers were enrolled. 67 nodules were histologically diagnosed (group 1) and 52 nodules were followed up with MR for at least 12 months (group 2); 4 nodules belonged to both groups. Two radiologists reviewed the initial and follow-up MR images to determine the size and signal intensities on unenhanced T1- and T2-weighted images, dynamic phases and HBP images in consensus. In addition, two pathologists reviewed the histologic findings including H&E staining and four kinds of immunohistochemical staining in group 1. Results: In group 1, 73.1% (49/67) of nodules were hepatocellular carcinomas. In group 2, 32.7% (17/52) of nodules developed arterial hypervascularity on follow-up, and 78.8% (41/52) showed at least one of the three imaging features considered to indicate malignant changes during follow-up (mean 19 ± 10 months): increase in diameter by ≥5 mm (23/52, 44.2%), arterialization (17/52, 32.7%) and hyperintensity on T2-weighted images (18/52, 34.6%). Conclusion: Our study results demonstrate that a significant proportion of non-hypervascular HBP hypointense nodules (≥1 cm in diameter) in patients with cirrhosis showed either malignant features on pathology (73.1%) or developed hypervascularity (32.7%) during follow-up.

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“…On the other hand, nonenhanced lesions in the arterial phase or hypervascular nodules without washout in the portal phase are found during the follow-up period in patients with high risk of hepatocarcinogenesis (2)(3)(4). The frequency of diagnosis of such nodules has increased since gadoxetic acidenhanced MRI has become clinically available (5)(6)(7).…”

Section: Introductionmentioning

confidence: 99%

Clinical correspondence to hepatocellular carcinoma-related lesions with atypical radiological pattern

Higaki

Midorikawa

Nakashima

et al. 2017

BST

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Presence of a hypovascular hepatic nodule showing hypointensity on hepatocyte‐phase image is a risk factor for hypervascular hepatocellular carcinoma

Abstract: Patients with chronic liver disease showing a hypointense hypovascular nodule in the liver on hepatocyte-phase EOB-MRI have a high risk of HCC development.

Cited by 30 publications

References 26 publications

Early hepatocellular carcinoma as a signaling lesion for subsequent malignancy

Early hepatocellular carcinoma as a signaling lesion for subsequent malignancy

Non-Hypervascular Hypointense Nodules ≥1 cm on the Hepatobiliary Phase of Gadoxetic Acid-Enhanced Magnetic Resonance Imaging in Cirrhotic Livers

Clinical correspondence to hepatocellular carcinoma-related lesions with atypical radiological pattern

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