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Vanishing washout of hepatocellular carcinoma according to the presence of hepatic steatosis: diagnostic performance of CT and MRI

  • Gastrointestinal
  • Published:
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Abstract

Objectives

To compare the presence of washout and the diagnostic performance of computed tomography (CT) and magnetic resonance imaging (MRI) for hepatocellular carcinoma (HCC) according to the presence of hepatic steatosis.

Methods

This retrospective study included 566 patients with chronic liver disease who had undergone hepatic resection for hepatic tumors (482 HCCs and 84 non-HCCs) between January 2016 and June 2018 and had available multiphasic CT and MR images. Patients were allocated in the fatty liver (n = 141) or non-fatty liver (n = 425) group according to the presence of hepatic steatosis, defined as lipid droplets in at least 5% of hepatocytes on pathological examination. The presence of HCC washout and the diagnostic performance of CT and MRI for HCC were compared between the groups.

Results

HCC washout was less frequently seen in the fatty liver group than in the non-fatty liver group on CT (61.5% vs. 88.9%, p < 0.001), whereas it was similarly present on MRI in both groups (77.0% vs. 74.4%, p = 0.565). For diagnosis of HCC, the sensitivity (53.3% vs. 80.0%, p < 0.001) and accuracy (53.9% vs. 80.9%, p < 0.001) of CT were lower in the fatty liver group than in the non-fatty liver group. However, for MRI, these values were not significantly different between the groups (p > 0.05).

Conclusions

Hepatic steatosis significantly decreased the performance of CT for the diagnosis of HCC, whereas it did not significantly alter the performance of MRI.

Key Points

• Unlike MRI, there is vanishing HCC washout on CT caused by the background hepatic steatosis.

• The diagnostic performance of CT for the diagnosis of HCC was significantly altered by hepatic steatosis.

• The optimal cutoff HU value of the liver parenchyma for the vanishing washout of HCC was < 50 HU on unenhanced CT images.

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Abbreviations

CT:

Computed tomography

EASL:

European Association for the Study of the Liver

HCC:

Hepatocellular carcinoma

HU:

Hounsfield unit

LI-RADS:

Liver Imaging Reporting and Data System

MRI:

Magnetic resonance imaging

NAFLD:

Non-alcoholic fatty liver disease

SI:

Signal intensity

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The authors state that this work has not received any funding.

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Author notes

  1. Yeon-Yoon Kim

    Present address: Department of Radiology and Research Institute of Radiological Science, Severance Hospital, Yonsei University College of Medicine, Seoul, South Korea

Authors and Affiliations

  1. Department of Radiology and Center for Imaging Science, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81 Irwon-Ro, Gangnam-gu, Seoul, 06351, South Korea

    Ji Hye Min, Tae Wook Kang, Yeon-Yoon Kim, Dong Ik Cha, Young Kon Kim & Seong Hyun Kim

  2. Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea

    Dong Hyun Sinn

  3. Department of Pathology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea

    Sang Yun Ha

  4. Biostatics and Clinical Epidemiology Center, Samsung Medical Center, Seoul, South Korea

    Kyunga Kim

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Correspondence to Tae Wook Kang.

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The scientific guarantor of this publication is Won Jae Lee.

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The authors of this manuscript declare no relationships with any companies, whose products or services may be related to the subject matter of the article.

Statistics and biometry

One (Kyunga Kim) of the authors has significant statistical expertise.

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• Retrospective

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• Performed at one institution

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Min, J.H., Kang, T.W., Kim, YY. et al. Vanishing washout of hepatocellular carcinoma according to the presence of hepatic steatosis: diagnostic performance of CT and MRI. Eur Radiol 31, 3315–3325 (2021). https://doi.org/10.1007/s00330-020-07438-9

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  • DOI: https://doi.org/10.1007/s00330-020-07438-9

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