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Non-hypervascular hepatobiliary phase hypointense nodules on gadoxetic acid-enhanced MR can help determine the treatment method for HCC

  • Hepatobiliary-Pancreas
  • Published:
European Radiology Aims and scope Submit manuscript

Abstract

Objective

This study was conducted in order to evaluate whether the presence of nonhypervascular hepatobiliary phase (HBP) hypointense nodules can help determine the treatment method for single nodular hepatocellular carcinoma (HCC) ≤ 3 cm.

Methods

This study was approved by the institutional review board. A total of 345 patients with single nodular HCC ≤ 3 cm underwent pretreatment gadoxetic acid-enhanced MR followed by hepatic resection (n = 123) or radiofrequency ablation (RFA) (n = 222). We retrospectively analyzed the results of tumor recurrence according to the presence of nonhypervascular HBP hypointense nodules at each treatment method.

Results

Nonhypervascular HBP hypointense nodules were found in 18 of 123 patients treated by hepatic resection and in 63 of 222 patients who underwent RFA. The presence of nonhypervascular HBP hypointense nodules was a significant affecting factor for recurrence-free survival (RFS) after both hepatic resection (p = 0.004, hazard ratio [HR] = 2.75 [1.38–5.51]) and RFA (p = 0.004, HR = 1.78 [1.20–2.63]). In patients with nonhypervascular HBP hypointense nodules, 5-year RFS was 34.0% after hepatic resection, which was not significantly different from the 28.0% after RFA (p = 0.618). However, in patients without nonhypervascular HBP hypointense nodules, 5-year RFS was 65.0% after hepatic resection, which was significantly better than the 51.0% after RFA (p = 0.042), owing to significantly lower cumulative incidence of local tumor progression after hepatic resection (p < 0.001).

Conclusions

While the presence of nonhypervascular HBP hypointense nodules on gadoxetic acid-enhanced MR taken prior to treatment was a significant predictive factor of tumor recurrence after both hepatic resection and RFA, in patients without nonhypervascular HBP hypointense nodules, hepatic resection can provide significantly better RFS than RFA.

Key Points

• The presence of nonhypervascular hepatobiliary phase (HBP) hypointense nodules was a significant risk factor for tumor recurrence after either hepatectomy or radiofrequency ablation (RFA).

• Hepatectomy provided significantly better recurrence-free survival than RFA in patients without nonhypervascular HBP hypointense nodules.

• In patients with nonhypervascular HBP hypointense nodules, recurrence-free survival after RFA was comparable to hepatectomy.

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Abbreviations

AFP:

Alpha-fetoprotein

CI:

Confidence interval

EM:

Extrahepatic metastasis

HBP:

Hepatobiliary phase

HCC:

Hepatocellular carcinoma

HR:

Hazard ratio

IDR:

Intrahepatic distant recurrence

LTP:

Local tumor progression

MR:

Magnetic resonance

RFA:

Radiofrequency ablation

RFS:

Recurrence-free survival

SD:

Standard deviation

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Funding

The authors state that there are no grants or funds supporting this study.

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Authors and Affiliations

  1. Department of Radiology, Seoul National University Hospital, 101 Daehangno, Jongno-gu, Seoul, 03080, South Korea

    Dong Ho Lee, Jeong Min Lee & Joon Koo Han

  2. Department of Radiology, Seoul National University College of Medicine, Seoul, South Korea

    Jeong Min Lee & Joon Koo Han

  3. Department of Radiology, Konkuk University School of Medicine, Seoul, South Korea

    Mi Hye Yu

  4. Department of Radiology, Healthcare System Gangnam Center, Seoul National University Hospital, Seoul, South Korea

    Bo Yun Hur

  5. Department of Surgery, Seoul National University Hospital, Seoul, South Korea

    Nam-Joon Yi, Kwang-Woong Lee & Kyung-Suk Suh

  6. Department of Internal Medicine, Seoul National University Hospital, Seoul, South Korea

    Jung-Hwan Yoon, Yoon Jun Kim, Jeong-Hoon Lee & Su Jong Yu

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  1. Dong Ho Lee
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Correspondence to Jeong Min Lee.

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The scientific guarantor of this publication is Jeong Min Lee.

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The authors declare that they have no conflict of interest.

Statistics and biometry

No complex statistical methods were necessary for this paper.

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Written informed consent was waived by the Institutional Review Board.

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Institutional Review Board approval was obtained.

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• Retrospective

• Observational

• Performed at one institution

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Lee, D.H., Lee, J.M., Yu, M.H. et al. Non-hypervascular hepatobiliary phase hypointense nodules on gadoxetic acid-enhanced MR can help determine the treatment method for HCC. Eur Radiol 29, 3122–3131 (2019). https://doi.org/10.1007/s00330-018-5941-x

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  • DOI: https://doi.org/10.1007/s00330-018-5941-x

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