European Radiology

, Volume 24, Issue 10, pp 2476–2481 | Cite as

Prognosis of small hepatocellular nodules detected only at the hepatobiliary phase of Gd-EOB-DTPA-enhanced MR imaging as hypointensity in cirrhosis or chronic hepatitis

  • Atsushi Higaki
  • Katsuyoshi Ito
  • Tsutomu Tamada
  • Teruki Sone
  • Akihiko Kanki
  • Yasufumi Noda
  • Kazuya Yasokawa
  • Akira Yamamoto



To evaluate the prognosis of “strict” high-risk nodules (small hepatocellular nodules detected only in the hepatobiliary phase of initial Gd-EOB-DTPA-enhanced MR examination) in patients with cirrhosis or chronic hepatitis.

Methods and materials

The study included thirty-three patients with 60 “strict” high-risk nodules showing hypointensity at the hepatobiliary phase that was undetectable at the vascular phase and other conventional sequences of initial Gd-EOB-DTPA-enhanced MR imaging. These nodules were observed on follow-up MR examinations until hypervascularity was detected. The potential predictive factors for hypervascular transformation were compared between two groups (group A showing hypervascular transformation, group B not showing hypervascularization).


Ten (16.7 %) of 60 “strict” high-risk nodules showed hypervascular transformation during follow-up periods (group A). The growth rates of the nodules in group A (6.3 ± 4.5 mm/year) were significantly higher than those in group B (3.4 ± 7.2 mm/year) (p = 0.003). Additionally, the median observation period in group A (177.5 ± 189.5 day) was significantly shorter than in group B (419 ± 372.2 day) (p = 0.045). The other predictive factors were not significantly correlated with hypervascularization.


Subsets of “strict” high-risk nodules showed hypervascular transformation during follow-up periods in association with increased growth rates, indicating that nodule growth rate is an important predictive factor for hypervascularization.

Key Points

• “Strict” high-risk nodules are defined as hepatocellular nodules detected only in the hepatobiliary-phase.

• Subsets of “strict” high-risk nodules showed hypervascular transformation during follow-up periods.

• Increased growth rate is an important predictive factor for hypervascular transformation.

• Management of patients with “strict” high-risk nodules becomes more appropriate.


Magnetic resonance imaging Gadolinium-ethoxybenzyl-diethylenetriamine pentaacetic acid (Gd-EOB-DTPA) Hepatocellular carcinoma Hepatocarcinogenesis Hypervascular transformation 



The scientific guarantor of this publication is Katsuyoshi Ito. 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. The authors state that this work has not received any funding.

No complex statistical methods were necessary for this paper. Institutional Review Board approval was obtained. Written informed consent was waived by the Institutional Review Board. No study subjects or cohorts have been previously reported.

Methodology: Retrospective, diagnostic or prognostic study, performed at one institution.


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Copyright information

© European Society of Radiology 2014

Authors and Affiliations

  • Atsushi Higaki
    • 1
  • Katsuyoshi Ito
    • 1
  • Tsutomu Tamada
    • 1
  • Teruki Sone
    • 1
  • Akihiko Kanki
    • 1
  • Yasufumi Noda
    • 1
  • Kazuya Yasokawa
    • 1
  • Akira Yamamoto
    • 1
  1. 1.Department of RadiologyKawasaki Medical SchoolKurashiki CityJapan

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