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Hypovascular hepatic nodules at gadoxetic acid-enhanced MRI: whole-lesion hepatobiliary phase histogram metrics for prediction of progression to arterial-enhancing hepatocellular carcinoma

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Abstract

Purpose

To explore whole-lesion histogram analysis of the hepatobiliary phase (HBP) defect in indeterminate hypovascular liver lesions for predicting progression to arterial-enhancing hepatocellular carcinoma (HCC).

Methods

Twenty patients undergoing gadoxetic acid-enhanced MRI for HCC screening with 12° and 25° flip angle (FA) HBP acquisitions demonstrating an indeterminate lesion showing HBP hypointensity but no arterial enhancement were included. Volumes-of-interest were placed on HBP defects, from which histogram metrics were obtained. Associations between these metrics and progression to arterial-enhancing HCC on follow-up imaging were investigated. Lesions were also assessed for the presence of a signal abnormality on conventional sequences.

Results

40% of lesions progressed to arterial-enhancing HCC; 60% were stable at ≥6 months follow-up. Neither T2-hyperintensity increased diffusion signal nor portal/equilibrium phase washout was different between progressing and nonprogressing lesions (p = 1.0). Among direct signal intensity-based measures (overall mean; mean of bottom 10th, 10–25th, and 25–50th percentiles), area-under-the-curve (AUC) for prediction of progression to arterial-enhancing HCC was consistently higher at 25° (range 0.619–0.657) than at 12° (range 0.512–0.548). However, at both FAs, the four measures with highest AUC were measures related to lesion texture and heterogeneity [standard deviation (SD), coefficient of variation (CV), skewness, and entropy], having AUC of 0.655–0.750 at 12° and 0.686–0.800 at 25. The metric with highest AUC at 12° was SD (AUC = 0.750) and at 25° was CV (AUC = 0.800).

Conclusion

Whole-lesion histogram HBP measures of indeterminate hypovascular liver lesions may help predict progression to arterial-enhancing HCC by reflecting greater lesion heterogeneity, particularly at higher FA. Larger studies are therefore warranted.

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Authors and Affiliations

  1. Department of Radiology, NYU School of Medicine, NYU Langone Medical Center, 550 First Avenue, New York, NY, 10016, USA

    Andrew B. Rosenkrantz, Niveditha Pinnamaneni, Andrea S. Kierans & Justin M. Ream

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  1. Andrew B. Rosenkrantz
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  2. Niveditha Pinnamaneni
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  3. Andrea S. Kierans
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  4. Justin M. Ream
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Correspondence to Andrew B. Rosenkrantz.

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Rosenkrantz, A.B., Pinnamaneni, N., Kierans, A.S. et al. Hypovascular hepatic nodules at gadoxetic acid-enhanced MRI: whole-lesion hepatobiliary phase histogram metrics for prediction of progression to arterial-enhancing hepatocellular carcinoma. Abdom Radiol 41, 63–70 (2016). https://doi.org/10.1007/s00261-015-0610-x

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  • DOI: https://doi.org/10.1007/s00261-015-0610-x

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