Usefulness of Gd-EOB-DTPA-enhanced MRI for evaluating the potential for early development of hepatocellular carcinoma after HCV eradication by direct-acting antiviral treatment

Abstract

Objective: The development of hepatocellular carcinoma (HCC) is not uncommon in patients who achieve eradication of the hepatitis C virus through direct-acting antiviral (DAA) treatment. The aim of this study was to identify the patients at high risk for novel HCC development after a sustained virologic response (SVR) by DAA treatment. Patients and Methods: A total of 518 patients with no history of HCC treatment and who achieved SVR by DAA treatment were evaluated retrospectively. The correlations between HCC development and the patients’ characteristics were evaluated. For patients who underwent gadolinium-ethoxybenzyl-diethylenetriamine pentaacetic acid (Gd-EOB-DTPA)-enhanced magnetic resonance imaging (MRI) or dynamic contrast-enhanced computed tomography, the relationship between the imaging findings and subsequent HCC development was also assessed. Results: HCC developed newly in 22 patients, and the 1-year and 3-year cumulative HCC rates were 2.0% and 8.5%, respectively. In multivariate analysis, a FIB-4 index >4.0 and a post-treatment α-fetoprotein >4.0 ng/ml were significant risk factors for HCC. In 26 of 118 patients who underwent an MRI before DAA treatment, a non-hypervascular hypo-intense nodule was seen in the hepatobiliary phase, and in 6 of 182 patients who underwent a CT, a non-hypervascular hypo-enhanced nodule was seen in the delayed phase. The sensitivity and specificity of the MRI-positive findings for the subsequent development of HCC were 0.92 and 0.87, respectively, and those of the CT were 0.40 and 0.99, respectively. In multivariate analysis of patients who underwent an MRI, a non-hypervascular hypo-intense nodule was the only factor that was significantly related to HCC development (HR 32.4, p = 0.001). Conclusion: Gd-EOB-DTPA-enhanced MRI was found to be reliable for risk evaluation of subsequent HCC development in patients after SVR by DAA treatment. Patients with a non-hypervascular hypo-intense nodule need more careful observation for incident HCC.

No increased risk of hepatocellular carcinoma after eradication of hepatitis C virus by direct-acting antivirals, compared with interferon-based therapy

“…Mariño Z, et al (28) reported the presence of non-characterized nodules before DAA was associated with a 3 times greater risk of HCC development. Therefore, screening of the early stage of HCC by other imaging modalities such as EOB-MRI before therapy could reduce the incidence of HCC after SVR since no lesions were detected by the US alone at baseline in our study and EOB-MRI is superior to detecting early HCC (29,30).…”

Hepatocellular carcinoma and hepatitis C virus treatments: The bold and the beautiful

“…A novel HCV fibrosis marker called M2BPGi has recently been described as a predictor of the development of HCC following SVR 64,120,121 . M2BPGi has been tested in HCC occurrence after SVR; however, in this cohort, In the multivariate study, M2BPGi was not a significant factor, although it might indicate additional factors, such as liver inflammation as it increases after acute liver injury 122 …”

Long‐term evolution of LI‐RADS observations in HCV‐related cirrhosis treated with direct‐acting antivirals

“…While prior studies have tried to identify demographic and clinical predictors of HCC development in patients treated with DAA, 11,12,31,32 scant data exist regarding the role of indeterminate lesions on the risk of de novo HCC. These data were limited by heterogeneous definition of indeterminate liver nodules and lack of information about the outcome of indeterminate nodules itself 33‐36 . Mariño et al 33 reported an increased relative risk of de novo HCC in cirrhotic patients with indeterminate liver nodules at ultrasound.…”

“…Similarly, Ooka et al 34 reported the presence of “dysplastic nodules” detected at CT or MRI as the only significant feature independently associated with HCC occurrence at 1‐year after DAA. Morimoto et al 35 described non‐hypervascular hypointense nodules on MRI as the only factor correlated with subsequent HCC development after DAA, while Toyoda et al 36 analysed the incidence of hypervascularization in non‐hypervascular hypointense nodules on gadoxetate disodium‐MRI demonstrating no difference in the development of arterial phase hyperenhancement in patient with eradicated HCV, compared to patient with persistent HCV infection. In clinical practice, indeterminate liver nodules may carry a higher risk of malignancy progression according to the combination of specific imaging features 19,37 .…”

“…These data were limited by heterogeneous definition of indeterminate liver nodules and lack of information about the outcome of indeterminate nodules itself. [33][34][35][36] 19,37 The LI-RADS algorithm may predict the outcome and time to progression based on the initial LI-RADS category and help identify the subset of observations that require a more aggressive management. 20,38 In our study the overall cumulative incidence of progression to LR-5 or LR-M was significantly higher in Interestingly, progression to LR-5 after DAA therapy most commonly occurred within 6 mo (67% of progressed observations in our study).…”