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Non-hypervascular hypointense nodules on Gd-EOB-DTPA-enhanced MRI as a predictor of outcomes for early-stage HCC

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Abstract

Background/purpose

In patients with hepatocellular carcinoma (HCC), gadolinium-ethoxybenzyl-diethylenetriamine pentaacetic acid (Gd-EOB-DTPA)-enhanced magnetic resonance imaging (MRI) often identifies non-hypervascular hypointense hepatic nodules during the hepatobiliary phase, but their prognostic significance is unclear. We conducted a prospective observational study to investigate the impact of non-hypervascular hypointense hepatic nodules detected by Gd-EOB-DTPA-enhanced MRI on the outcome of patients with early-stage HCC.

Methods

Post-treatment recurrence and survival rates were analyzed in 138 patients with non-recurrent, early-stage HCC [Barcelona Clinic Liver Cancer (BCLC) stage 0 or A] and Child-Pugh A liver function according to the presence of non-hypervascular hypointense nodules on pretreatment Gd-EOB-DTPA-enhanced MRI.

Results

Non-hypervascular hypointense hepatic nodules were detected in 51 (37.0 %) patients with early-stage HCC on pretreatment Gd-EOB-DTPA-enhanced MRI. Recurrence rates were significantly higher in patients with non-hypervascular hypointense nodules (p < 0.0001). Based on a multivariate analysis, the presence of non-hypervascular hypointense hepatic nodules on Gd-EOB-DTPA-enhanced MRI was independently associated with an increased recurrence rate, independent of tumor progression or treatment (p = 0.0005). The survival rate was significantly lower in patients with non-hypervascular hypointense nodules on Gd-EOB-DTPA-enhanced MRI (p = 0.0108).

Conclusions

In patients with early-stage typical HCC (BCLC 0 or A), the presence of concurrent non-hypervascular hypointense hepatic nodules in the hepatobiliary phase of pretreatment Gd-EOB-DTPA-enhanced MRI is an indicator of higher likelihood of recurrence after treatment and may be a marker for unfavorable outcome.

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Abbreviations

Gd-EOB-DTPA:

Gadolinium-ethoxybenzyl-diethylenetriamine pentaacetic acid

MRI:

Magnetic resonance imaging

HCC:

Hepatocellular carcinoma

US:

Ultrasonography

MDCT:

Multidetector-row computed tomography

BCLC:

Barcelona Clinic Liver Cancer

AASLD:

American Association for the Study of Liver Diseases

RFA:

Radiofrequency ablation

AFP:

Alpha-fetoprotein

AFP-L3:

Lens culinaris agglutinin-reactive alpha-fetoprotein

DCP:

Des-gamma-carboxy prothrombin

CTHA:

CT during hepatic arteriography

TACE:

Transarterial chemoembolization

ALT:

Alanine amonotransferase activity

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Compliance with ethical requirements and Conflict of interest

The entire protocol was approved by the hospital institutional review board and carried out in compliance with the Declaration of Helsinki. Written informed consent was obtained from all participating patients before the enrollment of the study. Hidenori Toyoda, Takashi Kumada, Toshifumi Tada, Yasuhiro Sone, Atsuyuki Maeda, and Yuji Kaneoka declare that they have no conflict of interest.

Author information

Authors and Affiliations

  1. Department of Gastroenterology, Ogaki Municipal Hospital, 4-86 Minaminokawa, Ogaki, Gifu, 503-8502, Japan

    Hidenori Toyoda, Takashi Kumada & Toshifumi Tada

  2. Department of Radiology, Ogaki Municipal Hospital, Ogaki, Japan

    Yasuhiro Sone

  3. Department of Surgery, Ogaki Municipal Hospital, Ogaki, Japan

    Atsuyuki Maeda & Yuji Kaneoka

Authors
  1. Hidenori Toyoda
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  2. Takashi Kumada
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  3. Toshifumi Tada
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  4. Yasuhiro Sone
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  5. Atsuyuki Maeda
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  6. Yuji Kaneoka
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Corresponding author

Correspondence to Hidenori Toyoda.

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Toyoda, H., Kumada, T., Tada, T. et al. Non-hypervascular hypointense nodules on Gd-EOB-DTPA-enhanced MRI as a predictor of outcomes for early-stage HCC. Hepatol Int 9, 84–92 (2015). https://doi.org/10.1007/s12072-014-9553-5

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  • DOI: https://doi.org/10.1007/s12072-014-9553-5

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